Department of Urology, Kerman University of Medical Sciences, Kerman, Iran.
World J Urol. 2024 Oct 3;42(1):559. doi: 10.1007/s00345-024-05265-x.
To compare the outcomes of transperitoneal and retroperitoneal laparoscopic pyelolithotomy procedures.
A total of 104 consecutive laparoscopic pyelolithotomy surgeries performed by a single surgeon on patients with staghorn or renal pelvic calculi larger than 20 mm were evaluated. Intraoperative and postoperative clinical parameters from two groups, transperitoneal (TLPL) (N = 55) and retroperitoneal (RLPL) (N = 49), were compared. The surgeon performed TLPL for the first five years and then switched to the RLPL approach for the next five years.
There were no significant differences in general demographic variables and stone size (26.55 vs. 24.73 mm, P = 0.8). Operation time and change in serum creatinine levels did not significantly differ between the two approaches. However, patients who underwent TLPL had longer hospital stays than RLPL (3.23 ± 1.21 vs. 2.36 ± 1.10 days, P = 0.0001). Additionally, TLPL was associated with a greater drop in hemoglobin levels (1.53 ± 1.04 vs. 1.17 ± 0.68, P = 0.04), higher rates of postoperative fever (12.7% vs. 0.0%, P = 0.01).
The retroperitoneal approach in laparoscopic pyelolithotomy for large renal pelvic stones resulted in fewer postoperative fevers, reduced hemoglobin drops, and shorter hospital stays than the transperitoneal approach. However, the stone-free rates were similar for both groups.
比较经腹腔和腹膜后腹腔镜肾盂切开取石术的效果。
回顾性分析了 104 例行腹腔镜肾盂切开取石术的患者资料，其中经腹腔途径（TLPL）55 例，经腹膜后途径（RLPL）49 例。比较两组患者的术中及术后临床参数。所有手术均由同一位医生完成，前 5 年采用 TLPL，后 5 年采用 RLPL。
两组患者的一般人口统计学变量和结石大小（26.55mm 比 24.73mm，P=0.8）无显著差异。两种手术方式的手术时间和血清肌酐水平变化无显著差异。但 TLPL 组患者的住院时间长于 RLPL 组（3.23±1.21d 比 2.36±1.10d，P=0.0001）。此外，TLPL 组血红蛋白水平下降更明显（1.53±1.04g/dl 比 1.17±0.68g/dl，P=0.04），术后发热率更高（12.7%比 0.0%，P=0.01）。
对于较大的肾盂结石，与经腹腔途径相比，经腹膜后途径行腹腔镜肾盂切开取石术术后发热更少，血红蛋白下降更少，住院时间更短，但两组的结石清除率相似。
