超微通道经皮肾镜取石术与传统微通道经皮肾镜取石术治疗1～2cm肾结石的倾向性评分匹配研究
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摘要
目的:倾向性评分匹配法(PSM)均衡组间协变量后,比较超微通道经皮肾镜取石术(SMP,F12～14)与传统微通道经皮肾镜取石术(mini-PCNL,F18)治疗1～2cm肾结石的安全性及临床效果。方法:回顾性分析2017年10月～2018年6月在我院收治的130例肾结石患者的临床资料,其中接受SMP治疗34例,接受mini-PCNL治疗96例。使用SPSS软件PSM功能对两组患者进行匹配,得到组间协变量均衡的样本,其中接受SMP治疗32例,接受mini-PCNL治疗32例,并用新样本进行比较分析。结果:SMP组及mini-PCNL组患者基线资料具有可比性。SMP组较mini-PCNL组术后住院时间更短[(3.4±1.1)d vs.(4.8±1.34)d,P=0.001]、无管化率更高(68.8%vs.43.8%,P=0.044),两组手术时间、总住院费用、术后即时结石清除率、最终结石清除率、术后止痛药物需求以及术后并发症差异均无统计学意义(P>0.05)。结论:与mini-PCNL比较,SMP减少了患者术后住院时间,提高了无管化率,改善了患者就医体验,SMP治疗1～2cm肾结石是安全、有效的。
Objective:To evaluate the clinical efficacy,safety,and cost of super-mini percutaneous nephrolithotomy(SMP,F12-14)and mini-percutaneous nephrolithotomy(mini-PCNL,F18)in the treatment for renal stones of 1-2 cm in size.Method:A retrospective comparative analysis of outcomes of 130 patients with renal stones of 1-2 cm in size who had undergone SMP or mini-PCNL was conducted between October 2017 and June2018.Thirty-four and 96 patients underwent SMP and mini-PCNL,respectively.Demographic data,clinical characteristics and perioperative outcomes were compared between the two groups.Propensity score-matching(PSM)analysis was performed to further compare the outcomes between the two groups.After matching,32 patients treated with SMP were compared to 32 patients treated with mini-PCNL.Result:Postoperative hospital stay was shorter for SMP compared with mini-PCNL(P=0.001).And SMP achieved a markedly higher tubeless rate than mini-PCNL did(P=0.044).No significant difference was found in mean operative time,total cost,initial stone free rate(SFR),final SFR,analgesic required or postoperative complication(P>0.05).Conclusion:We concluded that compared with mini-PCNL,SMP was also an effective alternative for renal stones of 1-2 cm in size with shorter hospital stay and higher tubeless rate.
Objective:To evaluate the clinical efficacy,safety,and cost of super-mini percutaneous nephrolithotomy(SMP,F12-14)and mini-percutaneous nephrolithotomy(mini-PCNL,F18)in the treatment for renal stones of 1-2 cm in size.Method:A retrospective comparative analysis of outcomes of 130 patients with renal stones of 1-2 cm in size who had undergone SMP or mini-PCNL was conducted between October 2017 and June2018.Thirty-four and 96 patients underwent SMP and mini-PCNL,respectively.Demographic data,clinical characteristics and perioperative outcomes were compared between the two groups.Propensity score-matching(PSM)analysis was performed to further compare the outcomes between the two groups.After matching,32 patients treated with SMP were compared to 32 patients treated with mini-PCNL.Result:Postoperative hospital stay was shorter for SMP compared with mini-PCNL(P=0.001).And SMP achieved a markedly higher tubeless rate than mini-PCNL did(P=0.044).No significant difference was found in mean operative time,total cost,initial stone free rate(SFR),final SFR,analgesic required or postoperative complication(P>0.05).Conclusion:We concluded that compared with mini-PCNL,SMP was also an effective alternative for renal stones of 1-2 cm in size with shorter hospital stay and higher tubeless rate.
引文
1 Zeng G,Wan S,Zhao Z,et al.Super-mini percutaneous nephrolithotomy(SMP):a new concept in technique and instrumentation[J].BJU Int,2016,117(4):655-661.
2 Liu Y,Wu W,Tuerxun A,et al.Super-Mini Percutaneous Nephrolithotomy in the Treatment of Pediatric Nephrolithiasis:Evaluation of the Initial Results[J].JEndourol,2017,31(S1):S38-S42.
3 Liu Y,AlSmadi J,Zhu W,et al.Comparison of supermini PCNL(SMP)versus Miniperc for stones larger than 2cm:apropensity score-matching study[J].World J Urol,2018,36(6):955-961.
4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)[J].临床泌尿外科杂志,2017,32(2):141-143.
5 Breda A,Ogunyemi O,Leppert J T,et al.Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2cm or greater--is this the new frontier?[J].JUrol,2008,179(3):981-984.
6 Abdelhafez M F,Wendt-Nordahl G,Kruck S,et al.Minimally invasive versus conventional large-bore percutaneous nephrolithotomy in the treatment of large-sized renal calculi:Surgeons preference?[J].Scand J Urol,2016,50(3):212-215.
7 Nagele U,Horstmann M,Sievert K D,et al.A newly designed amplatz sheath decreases intrapelvic irrigation pressure during mini-percutaneous nephrolitholapaxy:an in-vitro pressure-measurement and microscopic study[J].J Endourol,2007,21(9):1113-1116.
8 Li X,He Z,Wu K,et al.Chinese minimally invasive percutaneous nephrolithotomy:the Guangzhou experience[J].J Endourol,2009,23(10):1693-1697.
9 Zeng G,Zhu W,Liu Y,et al.The new generation supermini percutaneous nephrolithotomy(SMP)system:a step-by-step guide[J].BJU Int,2017,120(5):735-738.
10樊胜海,周立权.无管化经皮肾镜取石术的研究现状及进展[J].临床泌尿外科杂志,2016,31(10):943-946.
2 Liu Y,Wu W,Tuerxun A,et al.Super-Mini Percutaneous Nephrolithotomy in the Treatment of Pediatric Nephrolithiasis:Evaluation of the Initial Results[J].JEndourol,2017,31(S1):S38-S42.
3 Liu Y,AlSmadi J,Zhu W,et al.Comparison of supermini PCNL(SMP)versus Miniperc for stones larger than 2cm:apropensity score-matching study[J].World J Urol,2018,36(6):955-961.
4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)[J].临床泌尿外科杂志,2017,32(2):141-143.
5 Breda A,Ogunyemi O,Leppert J T,et al.Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2cm or greater--is this the new frontier?[J].JUrol,2008,179(3):981-984.
6 Abdelhafez M F,Wendt-Nordahl G,Kruck S,et al.Minimally invasive versus conventional large-bore percutaneous nephrolithotomy in the treatment of large-sized renal calculi:Surgeons preference?[J].Scand J Urol,2016,50(3):212-215.
7 Nagele U,Horstmann M,Sievert K D,et al.A newly designed amplatz sheath decreases intrapelvic irrigation pressure during mini-percutaneous nephrolitholapaxy:an in-vitro pressure-measurement and microscopic study[J].J Endourol,2007,21(9):1113-1116.
8 Li X,He Z,Wu K,et al.Chinese minimally invasive percutaneous nephrolithotomy:the Guangzhou experience[J].J Endourol,2009,23(10):1693-1697.
9 Zeng G,Zhu W,Liu Y,et al.The new generation supermini percutaneous nephrolithotomy(SMP)system:a step-by-step guide[J].BJU Int,2017,120(5):735-738.
10樊胜海,周立权.无管化经皮肾镜取石术的研究现状及进展[J].临床泌尿外科杂志,2016,31(10):943-946.