Management of large renal stones with super-mini percutaneous nephrolithotomy: an international multicentre comparative study
Management of large renal stones with super-mini percutaneous nephrolithotomy: an international multicentre comparative study
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超小型经皮肾镜取石术治疗大肾结石：一项国际多中心比较研究
DOI：
10.1111/bju.15066
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发表时间：
2020-05-25
影响因子：
4.5
通讯作者：
Zeng, Guohua
中科院分区：
文献类型：
--
作者：
Liu, Yang;Cai, Chao;Zeng, Guohua
目的比较超微型经皮肾镜取石术（SMP）和微型经皮肾镜取石术（Miniperc）治疗2 cm以上尿路结石的临床疗效。患者和方法2016年4月至2019年5月，在5个国家（中国、菲律宾、卡塔尔、英国和科威特）的20家三级医院进行了一项国际多中心回顾性队列研究。对3525例直径> 2cm的肾结石患者行SMP和Miniperc。主要终点是结石清除率（SFR）。次要结局包括：失血量、手术时间、术后疼痛评分、辅助操作、并发症、无管率和住院时间。结果SMP组2012例，Miniperc组1513例。匹配后，每组1380名患者被纳入进行进一步分析。总体而言，两组之间的平均手术时间或SFR无显著差异。而术后疼痛评分和住院时间均明显优于SMP（均P < 0.001）。SMP组的无管率明显高于对照组（72.6%vs57.8%，P < 0.001）。Miniperc组的术后发热更为常见（12.0% vs 8.4%，P = 0.002）。根据结石直径将患者进一步分为3个亚组（2-3，3-4和>4 cm）。SMP的优势在2-3 cm结石组中最为明显，随着结石尺寸的增加而减少，后两个亚组的手术时间更长。与Miniperc相比，SMP对3-4 cm结石的SFR相当，但对>4 cm结石的SFR较低。两组之间的输血和肾栓塞没有统计学差异。结论我们的数据表明，SMP是一个理想的治疗选择结石4厘米，手术时间延长。
Objectives To comparatively evaluate the clinical outcomes of super-mini percutaneous nephrolithotomy (SMP) and mini-percutaneous nephrolithotomy (Miniperc) for treating urinary tract calculi of >2 cm.Patients and Methods An international multicentre, retrospective cohort study was conducted at 20 tertiary care hospitals across five countries (China, the Philippines, Qatar, UK, and Kuwait) between April 2016 and May 2019. SMP and Miniperc were performed in 3525 patients with renal calculi with diameters of >2 cm. The primary endpoint was the stone-free rate (SFR). The secondary outcomes included: blood loss, operating time, postoperative pain scores, auxiliary procedures, complications, tubeless rate, and hospital stay. Propensity score matching analysis was used to balance the selection bias between the two groups.Results In all, 2012 and 1513 patients underwent SMP and Miniperc, respectively. After matching, 1380 patients from each group were included for further analysis. Overall, there was no significant difference in the mean operating time or SFR between the two groups. However, the hospital stay and postoperative pain score were significantly in favour of SMP (both P < 0.001). The tubeless rate was significantly higher in the SMP group (72.6% vs 57.8%, P < 0.001). Postoperative fever was much more common in the Miniperc group (12.0% vs 8.4%, P = 0.002). When the patients were further classified into three subgroups based on stones diameters (2-3, 3-4, and >4 cm). The advantages of SMP were most obvious in the 2-3 cm stone group and diminished as the size of the stone increased, with longer operating time in the latter two subgroups. Compared with Miniperc, the SFR of SMP was comparable for 3-4 cm stones, but lower for >4 cm stones. There was no statistical difference in blood transfusions and renal embolisations between the two groups.Conclusions Our data showed that SMP is an ideal treatment option for stones of 4 cm, with a prolonged operating time.