Lessons learned from the CROES percutaneous nephrolithotomy global study
Lessons learned from the CROES percutaneous nephrolithotomy global study
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DOI：
10.1007/s00345-014-1367-5
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发表时间：
2015-02-01
影响因子：
3.4
通讯作者：
de la Rosette, Jean J. M. C. H.
中科院分区：
文献类型：
--
作者：
Kamphuis, Guido M.;Baard, Joyce;de la Rosette, Jean J. M. C. H.
本文对CROES PCNL全球研究的25篇文献进行了综述，并与现有文献和指南进行了分析和比较。虽然仰卧位比俯卧位更有利，但本研究显示手术时间更长，结石清除率（SFR）更低。这可能是由于手术时间和残余结石评价方法的定义不同。超声（US）引导入路证明有利于缩短穿刺时间和减少辐射暴露。经皮肾镜取石术可以安全地治疗肾脏异常，其结局与正常情况相似。然而，在孤立肾患者中，SFR较低，出血较多。此外，严重的慢性肾脏病（CKD）患者的预后较差。经皮肾镜取石术后的并发症主要是发热（10.5%）和出血（7.8%）。一项配对对照分析证实，抗生素预防性治疗使术后发热率降低三倍。在多变量分析中，它优雅地证明了出血与扩张的大小直接相关：孔径越大，出血的机会越高。老年患者出现并发症的风险较高，住院时间较长。总体而言，肥胖患者的结局与一般人群相似;然而，超肥胖（BMI > 40）患者发生更严重并发症的可能性更高。该数据库首次阐明了PCNL的结果和并发症与病例量之间的显著关系。每个中心的最佳病例量似乎为120例PCNL/年。最后，我们还开发了一个列线图，可以更好地为患者提供咨询和决策。CROES PCNL全球研究是最大的现实生活研究，为一般和特殊情况提供了新的见解。由于纳入了大量患者，因此可以分析罕见疾病，包括肾脏异常、孤立肾和患者特征，如重度CKD、过度肥胖和老年。除此之外，还编制了列线图。并首次确定了案件量的影响。
The purpose of the study was to give an overview of the data derived from the CROES PCNL Global Study published previously in 25 articles.A comprehensive overview of the outcome of the CROES PCNL Global Study was made, analysed and compared with the current literature and guidelines.Percutaneous nephrolithotomy (PCNL) was predominately performed in prone position. Although the supine position claims to be favourable over the prone approach, the present study showed a longer operation time and lower stone-free rate (SFR). This might be explained by differences in definition in operation time and methods in the evaluation of residual stones. Ultrasound (US)-guided access proves beneficial in lowering puncture time and radiation exposure. Renal anomalies can safely be treated by PCNL and have similar outcomes to a normal situation. In patients with a solitary kidney, however, there is a lower SFR and more bleeding. Also, severe chronic kidney disease (CKD) patients have less favourable outcome. Morbidity and complications following PCNL are dominated by fever (10.5 %) and bleeding (7.8 %). A matched control analysis confirmed that antibiotic prophylaxis gives a threefold lower post-operative fever rate. In a multivariate analysis, it was elegantly demonstrated that bleeding was directly related to the size of the dilatation: the larger the bore, the higher the chance for bleeding. Elderly patients are at higher risk of complications and longer hospital stay. Overall, obese patients have similar outcome as the general population; however, super-obese (BMI > 40) patients have a higher chance of more severe complications. For the first time, this database illustrated a significant relationship between results and complications of PCNL, and caseload volume. The optimal case volume per centre appears to be 120 PCNL's/year. Finally, a nomogram has been developed that enables better patient counselling and decision-making.The CROES PCNL Global Study is the largest real-life study providing new insights into general and special conditions. Because of the vast number of patients included, rare conditions including renal anomalies, solitary kidneys and patient characteristics like severe CKD, super obesity and old age could be analysed. Besides this information, a nomogram was developed. And for the first time, the influence of caseload volume was established.