Minimally invasive versus standard endoscopic combined intrarenal surgery for renal stones: a retrospective pilot study analysis
Minimally invasive versus standard endoscopic combined intrarenal surgery for renal stones: a retrospective pilot study analysis
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DOI：
10.1007/s11255-020-02433-x
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发表时间：
2020-07-01
影响因子：
2
通讯作者：
Matsuzaki, Junichi
中科院分区：
文献类型：
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作者：
Usui, Kimitsugu;Komeya, Mitsuru;Matsuzaki, Junichi
目的：小型化与内镜联合肾内手术（ECIRS）联合应用的效果尚不清楚。因此，我们比较了使用16.5 Fr经皮穿刺鞘管的微创ECIRS（mini-ECIRS）和使用24 Fr穿刺鞘管的标准ECIRS治疗肾结石的治疗结局。材料和方法我们回顾性分析了2009年4月至2016年5月期间在改良Valdivia体位接受单次微型或标准ECIRS治疗肾结石的连续患者。为了调整患者特征，使用术前参数（包括年龄、性别、发热性尿路感染（UTI）史、结石表面积、受累肾盏数量和鹿角形结石）匹配77对患者。结果根据非造影CT，微型和标准ECIRS的结石清除率（SFR）相似（61.1%vs.52.0%，p = 0.388）。根据Clavien-Dindo分级，两组中超过2级的围手术期并发症发生率相似（19.5% vs. 26.0%，p = 0.442）。两组超过3级的严重并发症发生率也相似（2.6%vs.3.9%，p> 0.99）。在每组中观察到2例感染性休克。虽然在出血相关并发症方面没有差异（2.6% vs. 6.5%，p = 0.442），但在mini-ECIRS组中未观察到假性动脉瘤或输血。微型ECIRS组围手术期疼痛视觉模拟量表值较低（1.34 +/- 1.08 vs. 1.69 +/-1.23，p = 0.062）。结论本研究表明，与标准ECIRS相比，mini-ECIRS维持了SFR而不会增加围手术期并发症，倾向于减少术后疼痛，并有可能减少出血相关并发症。本报告提出了ECIRS小型化治疗肾结石的优点。
Purpose The effect of combining miniaturization with endoscopic combined intrarenal surgery (ECIRS) is unclear. Thus, we compared the treatment outcomes between minimally invasive ECIRS (mini-ECIRS) using 16.5 Fr percutaneous access sheath and standard ECIRS using 24 Fr access sheath for renal stones Materials and methods We retrospectively analyzed consecutive patients who underwent single session mini or standard-ECIRS in the modified Valdivia position for renal stones between April 2009 and May 2016. To adjust for patient characteristics, 77 pairs were matched using preoperative parameters including age, sex, history of febrile urinary tract infection (UTI), stone surface area, number of involved calyces, and staghorn calculi. Results The stone free rate (SFR) was similar between mini and standard ECIRS according to non-contrast computed tomography (61.1% vs. 52.0%,p = 0.388). The rate of perioperative complications exceeding grade 2 based on the Clavien-Dindo classification was similar in both groups (19.5% vs. 26.0%,p = 0.442). Severe complications exceeding grade 3 were also similar in both groups (2.6% vs. 3.9%,p > 0.99). Two cases of septic shock were noted in each group. Although there was no difference regarding bleeding-related complications (2.6% vs. 6.5%,p = 0.442), pseudoaneurysm or blood transfusion was not observed in the mini-ECIRS group. Pain visual analog scale values in the perioperative period were lower in the mini-ECIRS group (1.34 +/- 1.08 vs. 1.69 +/- 1.23,p = 0.062). Conclusions This study demonstrated that, compared to standard ECIRS, mini-ECIRS maintained SFR without increasing perioperative complications, tended to reduce postoperative pain and had a potential to reduce bleeding-related complications. This report suggests the advantages of ECIRS miniaturization for renal stones.