Multiperc Versus Single Perc with Flexible Instrumentation for Staghorn Calculi
Multiperc Versus Single Perc with Flexible Instrumentation for Staghorn Calculi
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DOI：
10.1089/end.2009.1535
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发表时间：
2009-10-01
影响因子：
2.7
通讯作者：
Desai, Mahesh R.
中科院分区：
文献类型：
--
作者：
Ganpule, Arvind P.;Mishra, Shashikant;Desai, Mahesh R.
已经描述了几种用于经皮切开和取石的技术。选择的方法取决于可用的器械，给定的距骨解剖中的结石负担，以及外科医生的偏好，取决于他或她的训练水平。使用或不使用灵活器械以彻底清除结石的多个策略性途径与单途径经皮肾镜取石术(PCNL)的争论仍在继续。“多通道”或多通道方法可以清除结石，而不需要增加复杂器械的成本；此外，能够实现一次通道的外科医生也可以很容易地创建二通道。这不需要克服学习曲线。反对MULPERC方法的论点是出血增加的可能性，这在任何已发表的系列中都没有得到证实。目前发表的不需要灵活内固定的单道方法适用于负担较小的部分鹿角形结石，在这些地方并不真正需要多个途径。使用单道PCNL配合灵活的器械，如输尿管镜和肾镜，理想情况下需要一种伴发并发症的胸骨上入路。这一手术的成功依赖于收集系统的解剖。到目前为止，很少有研究报道结石清除率不佳，具有住院时间短、出血量少的优点。目前可用的文献不够充分，因为大多数是回顾性研究，较少的患者收益，以及鹿角病例的稀少。需要采用正面比较的适当前瞻性研究来证明或反驳这两种方法的优点和缺点。
Several techniques have been described for percutaneous access and stone removal. The method of choice depends on the available instrumentation, stone burden in given caliceal anatomy, and the surgeon's preference, depending on his or her level of training. The argument for multiple strategic tracts vs single-tract percutaneous nephrolithotomy (PCNL) with or without flexible instrumentation for complete clearance of the stones is ongoing. The "multiperc'' or multiple tract approach offers clearance of stones without the added cost of sophisticated instrumentation; further, a surgeon who can achieve a primary tract can easily create secondary tracts. This does not require a learning curve to be overcome. The argument against the multiperc approach is a potential for increased bleeding, which has not been substantiated in any published series. The single-tract approach without need for flexible instrumentation, currently published, is for small burden and partial staghorn stone where multiple tracts are not really necessary. Use of single-tract PCNL with flexible instrumentation, such as ureteroscopy and nephroscopy, ideally needs a supracostal approach with its attendant morbidity. The success of this procedure depends on the collecting system anatomy. Few studies published to date report suboptimal stone clearance rates with the advantages of shorter hospital stay and less blood loss. The currently available literature is not sufficient because of mostly retrospective studies, fewer patient accrual, and paucity of staghorn cases. Proper prospective studies with head-on comparisons are needed to prove or disprove the advantages and disadvantages of either approach.