Nizzardo Marco, Albo Giancarlo, Ripa Francesco, Zino Ester, De Lorenzis Elisa, Boeri Luca, Longo Fabrizio, Montanari Emanuele, Zanetti Stefano Paolo
Department of Urology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
J Clin Med. 2024 Apr 26;13(9):2558. doi: 10.3390/jcm13092558.
Different suction-assisted nephrostomic sheaths have been developed for percutaneous nephrolithotomy (PCNL). (1) To examine PCNL techniques performed with different aspiration-assisted sheaths (Clear Petra sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath), with specific regard to effectiveness and safety outcomes in adult and paediatric patients; (2) to extrapolate intrarenal pressure (IRP) data during these procedures. A systematic literature search was performed in accordance with PRISMA guidelines. Relevant articles up to 8 February 2024 were included. Twenty-five studies were selected, thirteen retrospective and twelve prospective. The use of four different aspirating sheaths for miniPCNL was reported: Clear Petra sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath. Stone free rates (SFRs) across techniques ranged from 71.3% to 100%, and complication rates from 1.5% to 38.9%. Infectious complication rates varied from 0 to 27.8% and bleeding complication rates from 0 to 8.9%. Most complications were low grade ones. The trend among studies comparing aspiration- and non-aspiration-assisted miniPCNL was towards equivalent or better SFRs and lower overall infectious and bleeding complication rates in suction techniques. Operation time was consistently lower in suction procedures, with a mean shortening of the procedural time of 19 min. Seven studies reported IRP values during suction miniPCNL. Two studies reported satisfactory SFRs and adequate safety profiles in paediatric patient cohorts. MiniPCNL with aspirating sheaths appears to be safe and effective in both adult and paediatric patients. A trend towards a reduction of overall infectious and bleeding complications with respect to non-suction procedures is evident, with comparable or better SFRs and consistently shorter operative times. The IRP profile seems to be safe with the aid of aspirating sheaths. However, high quality evidence on this topic is still lacking.
已开发出不同的抽吸辅助肾造瘘鞘用于经皮肾镜取石术（PCNL）。（1）研究使用不同抽吸辅助鞘（Clear Petra鞘、Superperc、SuperminiPCNL和一种迷你PCNL专利鞘）进行的PCNL技术，特别关注成人和儿童患者的有效性和安全性结果；（2）推断这些手术过程中的肾内压（IRP）数据。按照PRISMA指南进行了系统的文献检索。纳入了截至2024年2月8日的相关文章。共选择了25项研究，其中13项回顾性研究和12项前瞻性研究。报告了用于迷你PCNL的四种不同抽吸鞘：Clear Petra鞘、Superperc、SuperminiPCNL和一种迷你PCNL专利鞘。各技术的结石清除率（SFR）在71.3%至100%之间，并发症发生率在1.5%至38.9%之间。感染性并发症发生率在0至27.8%之间，出血并发症发生率在0至8.9%之间。大多数并发症为轻度。比较抽吸辅助和非抽吸辅助迷你PCNL的研究趋势表明，抽吸技术的SFR相当或更好，总体感染和出血并发症发生率更低。抽吸手术的操作时间始终较短，平均手术时间缩短19分钟。七项研究报告了抽吸迷你PCNL期间的IRP值。两项研究报告了儿科患者队列中令人满意的SFR和足够的安全性。带抽吸鞘的迷你PCNL在成人和儿童患者中似乎都是安全有效的。与非抽吸手术相比，总体感染和出血并发症有减少的趋势，SFR相当或更好，手术时间始终更短。借助抽吸鞘，IRP情况似乎是安全的。然而，关于这一主题的高质量证据仍然缺乏。
