Tang Qing-Lai, Ji Jun-Biao, Tu Yun-Yun, Guo Ji-Dong, Wang Du-Jian, Zhou Xing-Zhu, Tao Rong-Zhen
Department of Urology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, 211100, Jiangsu, China.
Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Sci Rep. 2025 Aug 20;15(1):30523. doi: 10.1038/s41598-025-15887-9.
To observe the efficacy and safety of single-access minimally invasive percutaneous nephrolithotomy (MPCNL) combined with flexible cystoscopy and multi-access MPCNL in patients with complex renal stones (CRS). A total of 195 patients with CRS were prospectively randomized into two groups. Ninety-eight in the single-access MPCNL group and 97 cases as control in the multi-access MPCNL group. The stone-free rates (SFRs) at different times were considered as the primary outcome of the study. The secondary end points were operative time, hemoglobin decrease, postoperative hospital stay and operation-related complications. There was no obvious difference between two groups in patients' demographics and preoperative clinical characteristics (All P > 0.05). Postoperative data showed that mean decrease in hemoglobin level was less in single-access MPCNL group than that in multi-access MPCNL group (P < 0.001). Postoperative hospital stay in single-access MPCNL group was more shorten than that in multi-access MPCNL group (P < 0.001). Moreover, the SFRs of the postoperative 2nd day and 4th week in single-access MPCNL group were both significantly higher than those in multi-access MPCNL group (Both P < 0.05). However, in terms of the rates of low back pain, perirenal hematoma and renal artery embolization, multi-access MPCNL group were all significantly higher than single-access MPCNL group (All P < 0.05). Our study shows that single-access MPCNL and flexible cystoscopy are ideal complementary techniques in the treatment of CRS, satisfying both high SFR and minimized renal injury. This method was safe and reproducible in clinical practice.
观察单通道微创经皮肾镜取石术（MPCNL）联合软性膀胱镜检查与多通道MPCNL治疗复杂性肾结石（CRS）患者的疗效及安全性。将195例CRS患者前瞻性随机分为两组。单通道MPCNL组98例，多通道MPCNL组97例作为对照。不同时间的结石清除率（SFR）被视为研究的主要结局。次要终点为手术时间、血红蛋白下降、术后住院时间及手术相关并发症。两组患者的人口统计学和术前临床特征无明显差异（所有P>0.05）。术后数据显示，单通道MPCNL组血红蛋白水平的平均下降幅度低于多通道MPCNL组（P<0.001）。单通道MPCNL组术后住院时间比多通道MPCNL组更短（P<0.001）。此外，单通道MPCNL组术后第2天和第4周的SFR均显著高于多通道MPCNL组（均P<0.05）。然而，在腰痛、肾周血肿和肾动脉栓塞发生率方面，多通道MPCNL组均显著高于单通道MPCNL组（所有P<0.05）。我们的研究表明，单通道MPCNL和软性膀胱镜检查是治疗CRS的理想互补技术，既能实现高SFR又能将肾损伤降至最低。该方法在临床实践中安全且可重复。
