The selection of standard channel and microchannel percutaneous nephroscope in the treatment of urinary calculi
Mao Fei1, Liu Xiuheng1, Zhou Benzheng2, Weng Xiaodong1, Zhang Dahu2
1Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China; 2Department of Urology, Xiangyang No. 1 Hospital Affiliated to Hubei University of Medicine
Abstract：Objective:To compare microchannel percutaneous nephrolithotomy (mPCNL) with standard percutaneous nephrolithotomy (sPCNL) for the treatment of the urinary calculi and guide the selection. Methods:The patients with urinary stones who underwent a PCNL surgery in our hospital from January 2016 to January 2017 were chosen. Among them, the number of patients who had a sPCNL surgery and mPCNL was 47 and 31 respectively. The time of lithotripsy, the decrease of hemoglobin in preoperative and postoperative period, the time of hospitalization, the change of creatinine clearance before and after the surgery, the stone clearance rate at the first stage, abnormalities on WBC (>10×109/L) after the surgery, incidence of postoperative fever, and the incidence of other complications (including adjacent organ damage, blood transfusion, kidney high selective DSA, urinary pyemia) were compared between the two groups. Results:The operative time in sPCNL group (20.2±6.6 min) was shorter than that in mPCNL group (24.5±7.6 min, P<0.05). The decline of the Hb in sPCNL group (10.5±5.2 g/L) was more than that in the mPCNL group (11.0±5.3 g/L, P>0.05). The abnormal rate of WBC in sPCNL group (36.2%) was lower than that in the mPCNL group (61.3%, P<0.05). The time of hospitalization, the change of creatinine clearance, the stone clearance rate at the first stage, and postoperative fever incidence had no statistically significant difference between two groups. Conclusions:The time of lithotripsy by sPCNL in the treatment of upper urinary calculi (>2 cm), is shorter than that of mPCNL, and the abnormal rate of WBC after operation is lower in sPCNL group. There are no significant differences in surgical bleeding, the time of hospitalization, changes in creatinine clearance rate, postoperative fever incidence, and other complications between sPCNL and mPCNL.
毛飞, 刘修恒, 周本正, 翁小东, 张大虎. 标准通道与微通道经皮肾镜在治疗上尿路结石中的选择[J]. 微创泌尿外科杂志, 2018, 7(5): 302-305.
Mao Fei, Liu Xiuheng, Zhou Benzheng, Weng Xiaodong, Zhang Dahu. The selection of standard channel and microchannel percutaneous nephroscope in the treatment of urinary calculi. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(5): 302-305.
[1] 那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版).北京:人民卫生出版社,2013:129. [2] Druskin SC, Ziemba JB.Minimally invasive ("mini") percutaneous nephrolithotomy: classification, indications, and outcomes. Curr Urol Rep, 2016,17(4):30. [3] 周国保,余运旵,方小林,等.标准通道与微通道经皮肾镜碎石术治疗上尿路结石的疗效比较.安徽医学,2017,38(4):422-425. [4] 钟志刚. 24F通道和16F通道经皮肾镜取石术治疗肾结石的对比研究.广州:南方医科大学,2016. [5] 闫河峰,王天喜,刘涛,等.微通道经皮肾镜取石术与标准通道经皮肾镜取石术治疗肾结石疗效及对患者肾指标的影响.中国医学工程,2017,25(12):26-29. [6] 疏翀,项平,朱劲松.微通道和标准通道经皮肾镜碎石术治疗上尿路结石的疗效及对机体应激状态的影响.广西医科大学学报,2017,34(11):1614-1617. [7] Huang TY, Feng KM, Lo IS.Percutaneous nephrolithotomy: update, trends, and future directions for simultaneous supine percutaneous nephrolithotomy and retrograde ureterolithotripsy in the galdakao-modified supine valdivia position for large proximal ureteral calculi. Eur Urol, 2017,71(5):837-838. [8] 许全超,郭亮,张桃福,等.微通道经皮肾镜取石术治疗肾结石502例报道.安徽医药,2016,20(2):352-353. [9] Türk C, Petrík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol,2016,69(3):475-482. [10] Sakr A, Salem E, Kamel M, et al.Minimally invasive percutaneous nephrolithotomy vs standard PCNL for management of renal stones in the flank-free modified supine position: single-center experience. Urolithiasis,2017,45(6):585-589. [11] Wu C, Hua LX, Zhang JZ, et al.Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy. Kaohsiung J Med Sci,2017,33(1):36-43. [12] 陈宏宇,韩毅,孔垂泽,等.微通道和标准通道在经皮肾取石术中效果及安全性评价.中华腔镜泌尿外科杂志(电子版),2011,5(1):58-61. [13] 徐冉,李菘,赵洪清,等.微通道与标准通道经皮肾镜碎石术处理肾铸型结石疗效的比较.中南大学学报(医学版),2012,37(8):840-843. [14] Zhu W, Liu Y, Liu L, et al.Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis. Urolithiasis,2015,43(6):563-570. [15] 陈斌. 经皮肾镜碎石取石术后尿脓毒血症危险因素分析及防治进展.临床外科杂志,2017,25(2):96-99. [16] 王志勇, 李修明, 马光, 等. 标准通道经皮肾镜碎石术中肾盂内压的改变及对肾小球滤过率的影响. 中国内镜杂志,2018,24(1):11-16. [17] Guohua Z, Wen Z, Xun L, et al.The influence of minimally invasive percutaneous nephrolithotomy on renal pelvic pressure in vivo. Surg Laparosc Endosc Percutan Tech,2007,17(4):307-310. [18] Cheng F, Yu WM, Zhang XB, et al.Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol,2010,24(10):1579-1582.
