Aggarwal Puneet, Tandon Sanjeev
Senior Advisor (Surgery) & Urologist, Army Hospital (R & R), Delhi Cantt, India.
CSO Medical, Andaman & Nicobar Command HQ, India.
Med J Armed Forces India. 2024 Dec;80(Suppl 1):S232-S237. doi: 10.1016/j.mjafi.2023.10.008. Epub 2023 Dec 14.
Lower calyceal anatomy makes the stone clearance a difficult task across all treatment formats. Improvement in optics and miniaturization of instruments have offered an effective and safer alternative to percutaneous nephrolithotomy (PCNL). The study was conducted to compare the efficacy and complications associated with mini-PCNL vs standard-PCNL.
The study was a randomized control trial to compare mini-PCNL vs standard-PCNL for treatment of 1 to 2 cm inferior calyceal stones. Objectives were to compare peri-operative bleeding, operative-time, post-op analgesia requirement, hospital-stay and stone-free rate at 1 month. Patients with 1-2 cm inferior calyceal stones were included. Morbidly obese individuals, patients with renal malformation and paediatric age group were excluded.
One hundred and fifty seven patients were included out of 207 who underwent PCNL in this period. 80 underwent mini-PCNL and 77 standard-PCNL. Mini-PCNL scored over standard in hospital-stay (3.96 vs 4.73 days), post-operative analgesia requirement (2.58 vs 5.55 gms) and drop in Hb (0.59 vs 0.81 gm/dl). Even stone clearance rate was better for mini-PCNL (87.01% vs 93.75%). Mean surgery time was marginally better for standard-PCNL (44.03 vs 43.33 mins). Stone clearance rate and average surgery time were comparable with no statistically significant difference in the two groups. Analgesia requirement was statistically lower in mini-PCNL due to smaller tract and tubeless-PCNL. Hospital stay was statistically lower in mini-PCNL due to lesser post-operative pain. Peri-operative bleeding was statistically lower in mini-PCNL due to smaller track dilatation and lesser tract bleeding.
Mini-PCNL is a safe and effective treatment option in the management of 1-2 cm inferior calyceal stones with significantly less bleeding, shorter hospital-stay and analgesia requirement as compared to standard-PCNL with comparable stone clearance rates.
下盏的解剖结构使得在所有治疗方式中结石清除都成为一项艰巨任务。光学设备的改进和器械的小型化，为经皮肾镜取石术（PCNL）提供了一种有效且更安全的替代方法。本研究旨在比较微创PCNL与标准PCNL的疗效及并发症。
本研究为一项随机对照试验，比较微创PCNL与标准PCNL治疗1至2厘米的下盏结石。目的是比较围手术期出血、手术时间、术后镇痛需求、住院时间及1个月时的结石清除率。纳入1至2厘米下盏结石患者。排除病态肥胖个体、肾畸形患者及儿童年龄组。
在此期间接受PCNL的207例患者中，157例被纳入研究。80例行微创PCNL，77例行标准PCNL。微创PCNL在住院时间（3.96天对4.73天）、术后镇痛需求（2.58克对5.55克）及血红蛋白下降（0.59克/分升对0.81克/分升）方面优于标准PCNL。甚至微创PCNL的结石清除率也更好（87.01%对93.75%）。标准PCNL的平均手术时间略好（44.03分钟对43.33分钟）。两组的结石清除率和平均手术时间相当，无统计学显著差异。由于通道较小和无管PCNL，微创PCNL的镇痛需求在统计学上更低。由于术后疼痛较轻，微创PCNL的住院时间在统计学上更低。由于通道扩张较小和通道出血较少，微创PCNL的围手术期出血在统计学上更低。
微创PCNL是治疗1至2厘米下盏结石的一种安全有效的治疗选择，与标准PCNL相比，出血明显更少、住院时间更短、镇痛需求更少，结石清除率相当。
