Sakly Aymen, Zakhama Walid, Jleli Nejm, Chafik Anas, Binous Yassine
Department of urology, University Hospital Tahar SfarMahdia, Tunisia.
Ann Med Surg (Lond). 2023 Apr 1;85(5):1502-1506. doi: 10.1097/MS9.0000000000000576. eCollection 2023 May.
to compare the safety and the efficacy of standard percutaneous nephrolithotomy (sPCNL) vs. mini PCNL (mPCNL).
The authors conducted a prospective single-centre cohort study over a 2-year period of all consecutive patients who underwent sPCNL or mPCNL for 2-4 cm renal stones. Patients with active urinary tract infection, abnormal coagulopathy state, malformative uropathies and multitract-access procedures were excluded. In total, 90 patients underwent sPCNL using a 30 Fr access sheath with 24 Fr nephroscope while 52 patients underwent mPCNL using a mPCNL system: 12 Fr nephroscope and a 16.5/17.5F access sheath. Blood loss estimation was assessed postoperatively after 6 h by considering haemoglobin drop and blood transfusion if required. Stone free rate at 1 month was defined by the absence of stone or residual fragments less than or equal to 3 mm on computed tomography scan.
Stone characteristics were comparable in both treatment arms. The mean stone size was comparable for sPCNL and mPCNL groups (32.6±10.8 mm vs. 29.4±11.8 mm). Operative time was longer in the mPCNL group (124±40.4 min vs. 95.8±32.3 min, <0.001). According to the Clavien-Dindo classification, no statistical difference was found between the groups in terms of complication rate (=0.092). However, the mean of haemoglobin drop and transfusion rate were significantly in favour of mPCNL (1.43±1.5 vs. 0.88±1.4 g/dcl, =0.04). Hospital stay was found to be significantly shorter for patients undergoing mPCNL (4.4±3.9 vs. 2.7±1.7 days, <0.001). The success rate in the sPCNL group was higher than mPCNL group in terms of stone clearance at one month (69.4% vs. 62.7%, =0.06).
Both sPCNL and mPCNL have shown good outcomes in this indication. Although the stone free rate was equal for both techniques, hospital stay, bleeding and transfusion rate are much lower with the use of mPCNL.
比较标准经皮肾镜取石术（sPCNL）与微通道经皮肾镜取石术（mPCNL）的安全性和有效性。
作者进行了一项前瞻性单中心队列研究，为期2年，纳入所有因2 - 4厘米肾结石接受sPCNL或mPCNL的连续患者。排除有活动性尿路感染、凝血功能异常、泌尿系统畸形和多通道入路手术的患者。总共90例患者使用30F穿刺鞘和24F肾镜进行sPCNL，而52例患者使用mPCNL系统进行mPCNL：12F肾镜和16.5/17.5F穿刺鞘。术后6小时通过考虑血红蛋白下降情况及必要时的输血情况评估失血量。1个月时的结石清除率定义为计算机断层扫描显示无结石或残留碎片小于或等于3毫米。
两个治疗组的结石特征具有可比性。sPCNL组和mPCNL组的平均结石大小相当（32.6±10.8毫米对29.4±11.8毫米）。mPCNL组的手术时间更长（124±40.4分钟对95.8±32.3分钟，<0.001）。根据Clavien - Dindo分类，两组在并发症发生率方面未发现统计学差异（P = 0.092）。然而，血红蛋白下降均值和输血率明显有利于mPCNL（1.43±1.5对0.88±1.4克/分升，P = 0.04）。发现接受mPCNL的患者住院时间明显更短（4.4±3.9对2.7±1.7天，<0.001）。在1个月时的结石清除方面，sPCNL组的成功率高于mPCNL组（69.4%对62.7%，P = 0.06）。
sPCNL和mPCNL在该适应症中均显示出良好的结果。虽然两种技术的结石清除率相当，但使用mPCNL时住院时间、出血量和输血率要低得多。
