第三代超微经皮肾镜取石术治疗直径2.5 cm及以下高CT值肾结石的疗效及安全性评价
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摘要
目的对基层医院开展第三代超微通道经皮肾镜取石术(super-mini percutaneous nephrolithotomy,SMP)治疗直径≤2.5 cm、CT值≥700 Hu肾结石的疗效及安全性进行评估,探讨基层医院开展此项技术的可行性。方法选取2017年7月—2018年7月乐山市市中区人民医院收治的64例结石直径≤2.5 cm、CT值≥700 Hu的单侧肾结石患者,随机分为两组,其中采取SMP术30例,采取微通道经皮肾镜取石术(mini percutaneous nephrolithotomy,MPCNL)34例,对比分析两组患者术前资料和术中、术后相关技术资料,评价其疗效和安全性。结果两组患者单侧病变均一期顺利完成手术,所有患者术后均留置了双J管,无术后大出血和感染等重大并发症发生。两组在术后血红蛋白下降值、术后即刻清石率、术后1个月清石率、降钙素原>0.1μg/L率等技术指标上差异无统计学意义(P>0.05);SMP组和MPCNL组碎石时间分别为(29.63±6.28)、(25.21±5.19)min,术后住院时间分别为(5.33±0.61)、(9.44±0.96)d,留置肾造瘘管率分别为3.3%、50.0%,镇痛需求率分别为10.0%、58.8%,术后感染性发热率分别为6.7%、26.5%,组间差异均有统计学意义(P<0.05)。结论 SMP技术具有创伤小、可无管化、疼痛轻、恢复快、住院时间短等优点,值得广大基层医院推广。
Objective To evaluate the efficacy and safety of the third-generation super-mini percutaneous nephrolithotomy(SMP) for the treatment of kidney calculi with diameter of ≤2.5 cm and CT value of ≥700 Hu, and discuss the feasibility of adopting the technology in primary hospitals. Methods The clinical data of 64 patients with unilateral kidney calculi(CT value ≥700 Hu, diameter ≤2.5 cm) treated in the People's Hospital of Leshan Central District between July 2017 and July 2018 were retrospectively analyzed. After random assignment, 30 patients were treated with SMP and 34 were with mini percutaneous nephrolithotomy(MPCNL). The pre-, intra-, and postoperative data were compared and analyzed to evaluate the efficacy and safety. Results The unilateral lesion operations of both groups were successfully completed in the first phase. All patients were given double J tubes after operation, and there were no major complications such as post-operative hemorrhage and sepsis. There was no statistically significant difference in the post-operative hemoglobin decrease, post-operative immediate stone removal rate, post-operative stone removal rate after one month, or the rate of procalcitonin >0.1 μg/L between the two groups(P>0.05). The differences in the lithotripsy time [(29.63±6.28) vs.(25.21±5.19) minutes], post-operative hospital stay [(5.33±0.61) vs.(9.44±0.96) days],rate of indwelling renal fistula(3.3% vs. 50.0%), analgesic demand rate(10.0% vs. 58.8%), and postoperative infectious fever rate(6.7% vs. 26.5%) between SMP group and MPCNL group were statistically significant(P<0.05). Conclusions SMP has the advantages of less trauma, low systemic inflammatory response syndrome incidence, less pain, quick rehabilitation, short hospital stay, tubeless after surgery, etc. It is worthy of extensive promotion in primary hospitals.
Objective To evaluate the efficacy and safety of the third-generation super-mini percutaneous nephrolithotomy(SMP) for the treatment of kidney calculi with diameter of ≤2.5 cm and CT value of ≥700 Hu, and discuss the feasibility of adopting the technology in primary hospitals. Methods The clinical data of 64 patients with unilateral kidney calculi(CT value ≥700 Hu, diameter ≤2.5 cm) treated in the People's Hospital of Leshan Central District between July 2017 and July 2018 were retrospectively analyzed. After random assignment, 30 patients were treated with SMP and 34 were with mini percutaneous nephrolithotomy(MPCNL). The pre-, intra-, and postoperative data were compared and analyzed to evaluate the efficacy and safety. Results The unilateral lesion operations of both groups were successfully completed in the first phase. All patients were given double J tubes after operation, and there were no major complications such as post-operative hemorrhage and sepsis. There was no statistically significant difference in the post-operative hemoglobin decrease, post-operative immediate stone removal rate, post-operative stone removal rate after one month, or the rate of procalcitonin >0.1 μg/L between the two groups(P>0.05). The differences in the lithotripsy time [(29.63±6.28) vs.(25.21±5.19) minutes], post-operative hospital stay [(5.33±0.61) vs.(9.44±0.96) days],rate of indwelling renal fistula(3.3% vs. 50.0%), analgesic demand rate(10.0% vs. 58.8%), and postoperative infectious fever rate(6.7% vs. 26.5%) between SMP group and MPCNL group were statistically significant(P<0.05). Conclusions SMP has the advantages of less trauma, low systemic inflammatory response syndrome incidence, less pain, quick rehabilitation, short hospital stay, tubeless after surgery, etc. It is worthy of extensive promotion in primary hospitals.
引文
1Altunrende F, Tefekli A, Stein RJ, et a1. Clinically insignificant residual fragments after percutaneous nephrolithotomy:mediumterm follow-up. J Endourol, 2011, 25(6):941-945.
2 中华医学会重症医学分会.中国严重脓毒血症/脓毒性休克治疗指南(2014).中华内科学杂志, 2015, 54(6):557-581.
3Watterson JD, Soon S, Jana K, et al. Access related complications during percutaneous nephrolithotomy:urology versus radiology at a single academic institution. J Urol, 2006, 176(1):142-145.
4 韦巍,黄剑华,钟羽翔,等. 2~3 cm肾结石的CT值对输尿管软镜碎石效果的预估价值.中华腔镜泌尿外科杂志(电子版), 2019,13(2):95-98.
5Kamal W, Kallidonis P, Kyriazis I, et al. Minituriazed percutaneous nephrolithotomy:what does it mean?. Urolithiasis, 2016, 44(3):195-201.
6 郭景阳,杨文增,张彦桥,等.斜仰卧截石位单通道经皮肾镜联合经皮软镜治疗复杂肾结石的疗效观察.中国内镜杂志, 2017,23(4):95-97.
7Bader MJ, Gratzke C, Seitz M, et al. The “all-seeing needle”:initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol, 2011, 59(6):1054-1059.
8 Desai MR, Sharma R, Mishra S, et al. Single-step percutaneous nephrolithotomy(microperc):the initial clinical report. J Urol,2011, 186(1):140-145.
9Desai J, Solanki R. Ultra-mini percutaneous nephrolithotomy(UMP):one more armamentarium. BJU Int, 2013, 112(7):1046-1049.
10 Wright A, Rukin N, Smith D, et al.“Mini, ultra, micro”-nomenclature and cost of these new minimally invasive percutaneous nephrolithotomy(PCNL)techniques. Ther Adv Urol, 2016, 8(2):142-146.
11Zeng G, Wan S, Zhao Z, et al. Super-mini percutaneous nephrolithotomy(SMP):a new concept in technique and instrumentation. BJU Int, 2016, 117(4):655-661.
12 詹鹰,张宇聪,王康扬,等.超微经皮肾镜在上尿路结石治疗中的临床应用(附13例报告).临床泌尿外科杂志, 2017, 32(2):141-143.
13王亚园,许长宝,褚校涵,等.超微经皮肾镜与输尿管软镜治疗直径2-3 cm高CT值肾结石疗效对比.实用医学杂志, 2018,34(18):2181-2183.
14 Liu Y, AlSmadi J, Zhu W, et al. Comparison of super-mini PCNL(SMP)versus Miniperc for stones larger than 2 cm:a propensity score-matching study. World J Urol, 2018, 36(6):955-961.
15Cai C, Liu Y, Zhong W, et al. The clinical application of new generation super-mini percutaneous nephrolithotomy in the treatment of≥20 mm renal stones. J Endourol, 2019.
16 Zeng G, Zhu W, Lam W. Miniaturised percutaneous nephrolithotomy:its role in the treatment of urolithiasis and our experience. Asian J Urol, 2018, 5(4):295-302.
17Tepeler A, Armagan A, Sancaktutar AA, et al. The role of microperc in the treatment of symptomatic lower pole renal calculi. J Endourol, 2013, 27(1):13-18.
18 曾国华,万肖蓬,陈文忠,等.超微经皮肾镜取石术治疗31例肾结石的初步体会.中华泌尿外科杂志, 2014, 35(1):6-9.
19Sebaey A, Khalil MM, Soliman T, et al. Standard versus tubeless mini-percutaneous nephrolithotomy:a randomised controlled trial. Arab J Urol, 2016, 14(1):18-23.
2 中华医学会重症医学分会.中国严重脓毒血症/脓毒性休克治疗指南(2014).中华内科学杂志, 2015, 54(6):557-581.
3Watterson JD, Soon S, Jana K, et al. Access related complications during percutaneous nephrolithotomy:urology versus radiology at a single academic institution. J Urol, 2006, 176(1):142-145.
4 韦巍,黄剑华,钟羽翔,等. 2~3 cm肾结石的CT值对输尿管软镜碎石效果的预估价值.中华腔镜泌尿外科杂志(电子版), 2019,13(2):95-98.
5Kamal W, Kallidonis P, Kyriazis I, et al. Minituriazed percutaneous nephrolithotomy:what does it mean?. Urolithiasis, 2016, 44(3):195-201.
6 郭景阳,杨文增,张彦桥,等.斜仰卧截石位单通道经皮肾镜联合经皮软镜治疗复杂肾结石的疗效观察.中国内镜杂志, 2017,23(4):95-97.
7Bader MJ, Gratzke C, Seitz M, et al. The “all-seeing needle”:initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol, 2011, 59(6):1054-1059.
8 Desai MR, Sharma R, Mishra S, et al. Single-step percutaneous nephrolithotomy(microperc):the initial clinical report. J Urol,2011, 186(1):140-145.
9Desai J, Solanki R. Ultra-mini percutaneous nephrolithotomy(UMP):one more armamentarium. BJU Int, 2013, 112(7):1046-1049.
10 Wright A, Rukin N, Smith D, et al.“Mini, ultra, micro”-nomenclature and cost of these new minimally invasive percutaneous nephrolithotomy(PCNL)techniques. Ther Adv Urol, 2016, 8(2):142-146.
11Zeng G, Wan S, Zhao Z, et al. Super-mini percutaneous nephrolithotomy(SMP):a new concept in technique and instrumentation. BJU Int, 2016, 117(4):655-661.
12 詹鹰,张宇聪,王康扬,等.超微经皮肾镜在上尿路结石治疗中的临床应用(附13例报告).临床泌尿外科杂志, 2017, 32(2):141-143.
13王亚园,许长宝,褚校涵,等.超微经皮肾镜与输尿管软镜治疗直径2-3 cm高CT值肾结石疗效对比.实用医学杂志, 2018,34(18):2181-2183.
14 Liu Y, AlSmadi J, Zhu W, et al. Comparison of super-mini PCNL(SMP)versus Miniperc for stones larger than 2 cm:a propensity score-matching study. World J Urol, 2018, 36(6):955-961.
15Cai C, Liu Y, Zhong W, et al. The clinical application of new generation super-mini percutaneous nephrolithotomy in the treatment of≥20 mm renal stones. J Endourol, 2019.
16 Zeng G, Zhu W, Lam W. Miniaturised percutaneous nephrolithotomy:its role in the treatment of urolithiasis and our experience. Asian J Urol, 2018, 5(4):295-302.
17Tepeler A, Armagan A, Sancaktutar AA, et al. The role of microperc in the treatment of symptomatic lower pole renal calculi. J Endourol, 2013, 27(1):13-18.
18 曾国华,万肖蓬,陈文忠,等.超微经皮肾镜取石术治疗31例肾结石的初步体会.中华泌尿外科杂志, 2014, 35(1):6-9.
19Sebaey A, Khalil MM, Soliman T, et al. Standard versus tubeless mini-percutaneous nephrolithotomy:a randomised controlled trial. Arab J Urol, 2016, 14(1):18-23.