Rahaman M S, Bhuiyan M H R, Chowdhury P P, Biswas N P, Islam M A
Dr Md Saidur Rahaman, Registrar, Department of Urology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
Mymensingh Med J. 2025 Jan;34(1):79-84.
Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large kidney stones. Recent advancements in endoscopic technology and operative techniques have significantly increased the success rate of PCNL while reducing associated complications and morbidity. A key development contributing to this progress is the introduction of various new lithotripter techniques, which facilitate rapid stone fragmentation and clearance. The objective of the study was to compare the outcome of PCNL using pneumatic lithotripsy alone and combined lithotripsy (pneumatic and ultrasonic). This quasi-experimental study was conducted in the Urology Department of the National Institute of Kidney Diseases and Urology (NIKDU) in Dhaka, Bangladesh from April 2019 to March 2020. Thirty patients in Group A underwent PCNL using pneumatic lithotripsy, while another thirty patients in Group B underwent PCNL using combined lithotripsy. The two groups were compared in terms of stone size, operative time, hospital stay, hemoglobin loss, ancillary procedures, and initial and overall stone clearance rates. The mean age was 34.33±9.72 years (range 22-65 years) in Group A and 36.83±12.61 years (range 19-62 years) in Group B, with homogeneous distribution. There are 45 males and 15 females in two groups, resulting in a male-to-female ratio of 3:1. The mean stone size was 3.36±1.07 cm (range 2-6 cm) in Group A and 3.67±0.88 cm (range 2.4-6.0 cm) in Group B, with no significant differences between the groups. The mean operation time was significantly different: 67.50±13.2 minutes (range 40-86 minutes) for PCNL with pneumatic lithotripsy compared to 57.30±10.9 minutes (range 45-95 minutes) for combined lithotripsy (p<0.05). The mean postoperative hemoglobin drop was 1.37±0.50 g/dL in the pneumatic lithotripsy group, significantly higher than the 1.12±0.46 g/dL drop in the combined lithotripsy group (p<0.05). Other variables, including stone-free rate, postoperative hospital stay, and postoperative complications, showed no significant differences between the groups. The combined lithotriptripsy (pneumatic and ultrasonic) signify superior efficacy in PCNL compared to the pneumatic lithotriptripsy alone, as it remarkably reduces both the total operative time and blood loss.
经皮肾镜取石术（PCNL）是治疗大肾结石的金标准。内镜技术和手术技术的最新进展显著提高了PCNL的成功率，同时减少了相关并发症和发病率。促成这一进展的一个关键发展是引入了各种新的碎石技术，这些技术有助于快速碎石和清除结石。本研究的目的是比较单纯使用气压弹道碎石术和联合碎石术（气压弹道和超声）进行PCNL的效果。这项准实验研究于2019年4月至2020年3月在孟加拉国达卡的国家肾脏疾病和泌尿外科研究所（NIKDU）泌尿外科进行。A组30例患者采用气压弹道碎石术进行PCNL，而B组另外30例患者采用联合碎石术进行PCNL。比较两组的结石大小、手术时间、住院时间、血红蛋白丢失、辅助手术以及初始和总体结石清除率。A组的平均年龄为34.33±9.72岁（范围22 - 65岁），B组为36.83±12.61岁（范围19 - 62岁），分布均匀。两组共有45例男性和15例女性，男女比例为3:1。A组的平均结石大小为3.36±1.07 cm（范围2 - 6 cm），B组为3.67±0.88 cm（范围2.4 - 6.0 cm），两组之间无显著差异。平均手术时间有显著差异：气压弹道碎石术的PCNL平均手术时间为67.50±13.2分钟（范围40 - 86分钟），而联合碎石术为57.30±10.9分钟（范围45 - 95分钟）（p<0.05）。气压弹道碎石术组术后血红蛋白平均下降1.37±0.50 g/dL，显著高于联合碎石术组的1.12±0.46 g/dL下降幅度（p<0.05）。其他变量，包括结石清除率、术后住院时间和术后并发症，两组之间无显著差异。与单纯气压弹道碎石术相比，表示联合碎石术（气压弹道和超声）在PCNL中具有更高的疗效，因为它显著减少了总手术时间和失血量。
