Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana.
Bas¸kent University, Alanya Application and Research Center, Alanya.
Arch Ital Urol Androl. 2024 May 6;96(2):12369. doi: 10.4081/aiua.2024.12369.
In this study, the aim was to compare the results of mini and standard percutaneous nephrolithotomy (PCNL) for the treatment of pediatric kidney stones.
Data for 128 patients < 18 years of age who underwent mini and standard PCNL due to pediatric kidney stones were retrospectively examined. Patients were divided into two groups: mini-PCNL (16-20 Fr) and standard PCNL (26 Fr). Surgery time, number of punctures to the pelvicalyceal system, hospital stay, postoperative hemoglobin drop, complications and stone-free status (SFR) were compared between the groups. Additional surgical intervention (double-J stent, ureterorenoscopy, secondary PCNL) performed after the surgery was recorded. The absence of residual stones or < 3 mm residual stones on kidney, ureter and bladder radiography (KUB) and ultrasonography (USG) performed in the third postoperative month were accepted as success criteria.
There were 32 (43.8%) patients in the mini-PCNL group and 41 (56.2%) patients in the standard PCNL group. The mean age was 9.3 ± 4.1 years in the mini-PCNL group and 10.1 ± 5.4 years in the standard PCNL group. Mean stone size in the mini-PCNL group was 2.1 ± 1.2; while for standard PCNL it was 2.3 ± 1.4. The mean surgery time was statistically significantly higher in the mini-PCNL group (p = 0.005). There was no difference between the groups in terms of intraoperative double J stent use, postoperative complications and SFR. A double J stent was inserted in two patients in the mini-PCNL group and in one patient in the standard PCNL group due to urine leakage from the nephrostomy tract in the postoperative period. Although the postoperative hemoglobin drop was found to be significantly higher in standard PCNL (p = 0.001), hematuria and blood transfusion rates were low in both groups. Mean hospital stay was shorter in the mini-PCNL group compared to standard PCNL (3.6 ± 1.2 days vs. 2.5 ± 1.1; p = 0.018).
Although mini-PCNL has longer surgery time compared to standard PCNL, it should be preferred for the treatment of pediatric kidney stones due to advantages such as similar success and complication rates to standard PCNL, short hospital stay and less postoperative hemoglobin drop.
本研究旨在比较微通道和标准经皮肾镜取石术（PCNL）治疗小儿肾结石的效果。
回顾性分析了 128 例因小儿肾结石接受微通道和标准 PCNL 治疗的患者资料。患者被分为两组：微通道 PCNL（16-20Fr）和标准 PCNL（26Fr）。比较两组的手术时间、肾盂肾盏穿刺次数、住院时间、术后血红蛋白下降值、并发症和结石清除率（SFR）。记录术后额外的手术干预（双 J 支架、输尿管软镜、二期 PCNL）。术后第 3 个月行腹部平片（KUB）和超声（USG）检查，若未见残余结石或残余结石直径＜3mm，则视为成功。
微通道 PCNL 组 32 例（43.8%），标准 PCNL 组 41 例（56.2%）。微通道 PCNL 组的平均年龄为 9.3±4.1 岁，标准 PCNL 组为 10.1±5.4 岁。微通道 PCNL 组的结石平均大小为 2.1±1.2cm，标准 PCNL 组为 2.3±1.4cm。微通道 PCNL 组的手术时间明显长于标准 PCNL 组（p=0.005）。两组术中双 J 支架使用、术后并发症及 SFR 无差异。微通道 PCNL 组有 2 例和标准 PCNL 组有 1 例因术后经皮肾造瘘管漏尿而留置双 J 支架。标准 PCNL 组术后血红蛋白下降值明显高于微通道 PCNL 组（p=0.001），但两组的血尿和输血发生率均较低。微通道 PCNL 组的平均住院时间短于标准 PCNL 组（3.6±1.2d 比 2.5±1.1d；p=0.018）。
虽然微通道 PCNL 的手术时间比标准 PCNL 长，但因其与标准 PCNL 具有相似的成功率和并发症发生率、较短的住院时间和较少的术后血红蛋白下降值，因此对于小儿肾结石的治疗，应优先考虑微通道 PCNL。
