背景:目前,泌尿外科指南推荐经皮肾镜取石术(PCNL)作为鹿角形肾结石(SRC)的首选治疗方法.然而,对于完整的SRC,由于结石残留率高,临床医生和患者对此提出了质疑,并发症,反复住院,治疗费用高。萎缩性肾镜取石术(ANL)是治疗SRC的传统和经典方法。由于其创伤大,技术要求高,很难在基层医院进行,并逐渐被PCNL取代。本研讨旨在比拟PCNL和ANL医治完全性SRC的疗效。
方法:总的来说,238例完全SRC患者分为侧卧位mini-PCNL组,(n=190)和ANL组(n=94)根据治疗情况进行回顾性队列研究。微积分参数,肾功能指标,结石的合并症,手术并发症,住院时间和频率,治疗费用,比较两组患者术后满意度调查结果。
结果:侧卧位微型PCNL术后残余结石率的风险为239倍(OR=238.667,P<0.0001),残余结石数1.3倍(OR=1.326,P<0.0001),结石残留量是ANL的2.2倍(OR=2.224,P<0.0001)。侧卧位微型PCNL术后初始治疗费用的风险为3.3倍(OR=3.273,P<0.0001),治疗总费用4次(OR=4.051,P<0.0001),住院时间是ANL的1.4倍(OR=1.44,P<0.0001),外侧仰卧位的ANL术后肾萎缩发生率是微型PCNL的2.2倍(OR=2.171,P=0.008).在24个月的随访中,ANL后的肾小球滤过率(GFR)降低是外侧仰卧位mini-PCNL后的1.4倍(OR=1.381,P=0.037)。侧卧位ANL总体满意度的风险是mini-PCNL的58倍(OR=57.857,P<0.0001),鹿角分支数大于8是侧卧位微型PCNL术后残余结石发生的高危因素(OR=353.137,P<0.0001)。
结论:尽管在外侧仰卧位中,ANL后肾萎缩和GFR降低的风险高于mini-PCNL,传统ANL治疗完全性SRC的疗效普遍优于侧卧位微型PCNL。此外,大于8的鹿角分支的数量是完整SRC的优选ANL。
背景:ChiCTR2100047462。该试验已在中国临床试验注册中心注册;注册日期:2021年6月19日。
BACKGROUND: At present, the guidelines for urology recommend percutaneous nephrolithotomy (PCNL) as the preferred treatment for staghorn renal calculi (SRC). However, for complete SRC, it has been questioned by clinicians and patients due to high residual stone rate, complications, repeated hospitalizations and high treatment cost. Anatrophic nephrolithotomy (ANL) is a traditional and classic method for the treatment of SRC. Due to its high trauma and high technical requirements, it is difficult to carry out in primary hospitals, and gradually replaced by PCNL. The purpose of this study is to compare the efficacy of PCNL and ANL in the treatment of complete SRC.
METHODS: Overall, 238 patients with complete SRC were divided into mini-PCNL in lateral supine position group, (n = 190) and ANL group (n = 94) according to treatment for a retrospective cohort study. The calculi parameters, renal function index, comorbidities of calculi, surgical complications, length and frequency of hospitalization, treatment costs, results of postoperative satisfaction survey were compared between the two groups.
RESULTS: The risk of the residual stone rate after mini-PCNL in lateral supine position was 239 times (OR = 238.667, P < 0.0001), the number of residual stone 1.3 times (OR = 1.326, P < 0.0001), the amount of residual stone 2.2 times (OR = 2.224, P < 0.0001) that of ANL. The risk of the cost of initial treatment after mini-PCNL in lateral supine position was 3.3 times (OR = 3.273, P < 0.0001), the total cost of treatment 4 times (OR = 4.051, P < 0.0001), the total length of hospital stays 1.4 times (OR = 1.44, P < 0.0001) that of ANL, the incidence of postoperative renal atrophy was 2.2 times (OR = 2.171, P = 0.008) higher in the ANL than in the mini-PCNL in lateral supine position. Glomerular filtration rate (GFR) reduction after ANL was 1.4 times (OR = 1.381, P = 0.037) greater than that after mini-PCNL in lateral supine position at 24-month follow-up. The risk of the overall satisfaction of ANL was 58 times (OR = 57.857, P < 0.0001) higher than that of mini-PCNL in lateral supine position, the number of branches of staghorn greater than 8 is a high risk factor for the occurrence of residual stone after mini-PCNL in lateral supine position (OR = 353.137, P < 0.0001).
CONCLUSIONS: Although the risk of renal atrophy and decreased GFR after ANL is higher than that of mini-PCNL in lateral supine position, the efficacy of traditional ANL in the treatment of complete SRC was generally superior to that of mini-PCNL in lateral supine position. Moreover, number of branches of staghorn greater than 8 are the preferred ANL for complete SRC.
BACKGROUND: ChiCTR2100047462. The trial was registered in the Chinese Clinical Trial Registry; registration date: 19/06/2021.