Minimally invasive percutaneous nephrolithotomy versus endoscopic combined intrarenal surgery with flexible ureteroscope for partial staghorn calculi: A randomised controlled trial
Minimally invasive percutaneous nephrolithotomy versus endoscopic combined intrarenal surgery with flexible ureteroscope for partial staghorn calculi: A randomised controlled trial
复制标题
微创经皮肾镜取石术与输尿管软镜联合肾内手术治疗部分鹿角形结石的随机对照试验
DOI：
10.1016/j.ijsu.2016.02.056
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发表时间：
2016-04-01
影响因子：
15.3
通讯作者：
Wang, Bohan
中科院分区：
文献类型：
--
作者：
Wen, Jiaming;Xu, Gang;Wang, Bohan
背景：比较galdakao改良仰卧位（GMSV）与微创经皮肾镜取石术（MPCNL）同时经皮肾镜取石联合柔性输尿管镜取石术治疗部分鹿角型结石的疗效和安全性。方法：67例部分鹿角型结石患者随机分为两组。MPCNL组采用俯卧位行常规MPCNL。在另一组，同时联合MPCNL和输尿管镜碎石术（内镜联合肾内手术，ECIRS）作为GMSV位的单次治疗（ECIRS组）。记录人口统计学、临床特征、围手术期并发症及结石无结石率（SFR）。结果：两组患者年龄、体重指数、肾积水、结石负担、部位差异无统计学意义。ECIRS组平均手术时间为105.33 +/- 30.28 min， MPCNL组平均手术时间为83.58 +/- 24.37 min （p = 0.002）。ECIRS组的一步SFR显著高于MPCNL组（87.88% vs 58.82%） （p = 0.007）。ECIRS组平均失血量77.21 +/- 41.21 ml， MPCNL组平均失血量86.43 +/- 35.61 ml （p = 0.330）。两组患者并发症发生率均较低。两组临床并发症发生率比较，差异无统计学意义（p = 0.409）。经辅助治疗后，ECIRS组的最终SFR为96.97%，MPCNL组为91.18% （p = 0.628）。结论：MPCNL联合输尿管镜碎石术是治疗部分鹿角型结石的一种有效且安全的方法，与传统的MPCNL单药治疗相比，一步SFR显著提高，且无其他手术相关并发症。(C) 2016 IJS出版集团有限公司Elsevier Ltd.出版。版权所有。
Background: To compare the efficacy and safety of simultaneous percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy in Galdakao-Modified Supine Valdivia position (GMSV) with minimally invasive percutaneous nephrolithotomy (MPCNL) for partial staghorn calculi.Methods: 67 patients with partial staghorn calculi were randomly divided into two groups. In MPCNL Group, conventional MPCNL was performed in the prone position. In the other group, simultaneous combined MPCNL and flexible ureteroscopic lithotripsy (Endoscopic Combined Intra-Renal Surgery, ECIRS) serves as single session treatment in the GMSV position (ECIRS Group). Demographic, clinical characteristic, perioperative complications and stone free rate (SFR) were recorded.Results: No significant difference was detected between two groups concerning the age, body mass index, hydronephrosis, stone burden and location. The mean operative time was 105.33 +/- 30.28 min in ECIRS group, which is longer (p = 0.002) than MPCNL group (83.58 +/- 24.37 min). The one-step SFR was significantly higher (p = 0.007) in the ECIRS group compared to MPCNL group (87.88% vs 58.82%). The mean blood loss was 77.21 +/- 41.21 ml for ECIRS group and 86.43 +/- 35.61 ml for MPCNL group (p = 0.330). Overall, complication rate is low in both groups. No statistical difference was found in regards to the clinical complications between the two groups (p = 0.409). After the ancillary treatments, the final SFR was 96.97% in ECIRS group and 91.18% in MPCNL group (p = 0.628).Conclusion: Simultaneous combined MPCNL and flexible ureteroscopic lithotripsy is an effective and safe treatment for partial staghorn calculi, with significantly higher one-step SFR when compared to conventional MPCNL monotherapy, without additional procedure-related complications. (C) 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.