对比评价超微型经皮肾镜取石术(SMP)与微型经皮肾镜取石术(Miniperc)治疗>2cm尿路结石的临床疗效。
国际多中心,回顾性队列研究在五个国家的20家三级医院进行(中国,菲律宾,卡塔尔,英国,和科威特)在2016年4月至2019年5月之间。对3525例直径>2cm的肾结石患者进行了SMP和Miniperc。主要终点是无结石率(SFR)。次要结果包括:失血,操作时间,术后疼痛评分,辅助程序,并发症,无内胎率,住院。采用倾向评分匹配分析平衡两组间的选择偏倚。
总之,2012年和1513例患者接受了SMP和Miniperc,分别。匹配后,每组1380名患者被纳入进一步分析。总的来说,两组的平均手术时间和SFR差异无统计学意义.然而,住院时间和术后疼痛评分均显著有利于SMP(均P<0.001).SMP组的无管化率显着高于SMP组(72.6%vs57.8%,P<0.001)。术后发热在Miniperc组更为常见(12.0%vs8.4%,P=0.002)。当根据结石直径(2-3、3-4和>4cm)将患者进一步分为三个亚组。SMP的优势在2-3cm结石组中最为明显,并且随着结石大小的增加而减弱,在后两个亚组中具有更长的操作时间。与Miniperc相比,SMP的SFR与3-4厘米结石相当,但低于>4厘米的石头。两组在输血和肾栓塞方面无统计学差异。
我们的数据表明,SMP是<4cm结石的理想治疗选择,对2-3cm结石更有效。术后发热较少,失血,和疼痛相比Miniperc.SMP对>4厘米的结石效果较差,延长操作时间。
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.
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.
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.
Our data showed that SMP is an ideal treatment option for stones of <4 cm and is more efficacious for stones of 2-3 cm, with lesser postoperative fever, blood loss, and pain compared to Miniperc. SMP was less effective for stones of >4 cm, with a prolonged operating time.