微通道经皮肾取石术与传统经皮肾取石术的比较

Comparison of Minimally Invasive Percutaneous Nephrolithotomy and Standard Percutaneous Nephrolithotomy

目的微通道或微创经皮肾取石术(MPCNL)一种改良的经皮肾镜取石术,理论上通道的减小降低了传统(标准)经皮肾镜取石术(PCNL)的创伤性、使用纤细的镜体能到达肾内集合系统更多区域提高了结石的取净率,但MPCNL是否具有优越性尚存在争议。我们对MPCNL与文献报道的PCNL作一比较论述。方法回顾分析在我院行MPCNL治疗的患者资料并与传统PCNL的文献数据行比较研究。结果 3610例患者行4760次MPCNL,其中单通道取石2790例,多通道取石820例。平均手术时间78min,肾造瘘管平均留置时间6.8d。术后第2天及1个月后复查无石率分别为89%及91%。31例(0.67%)并发严重并发症,其中严重出血13例,胸膜损伤7例,尿源性脓毒症9例,肾周脓肿1例,围手术期死亡1例。与传统PCNL的文献相比,MPCNL在大出血、输血率、脓毒症和周围器官损伤的发生率均低于传统PCNL。结论 MPCNL是处理各种上尿路结石安全有效的方法。与传统PCNL相比,MPCNL减少了重大并发症的发生,提高了结石清除率。

Objective Mini-tract or minimally invasive percutenaous nephrolithotomy（MPCNL） is a modified PCNL which is performed via a smaller percutenaous tract.Theoretically,smaller tract decreases the risk of traditional PCNL and using miniature endoscope to reach more calyxes improves the stone-free rate.However,whether the MPCNL is superior to standard PCNL remains controversial.We compared the advantages and the disadvantages between MPCNL and standard PCNL.Methods The clinical data of patients who underwent MPCNL were analyzed and compared with the data of standard PCNL reported in current literatures.Results 4 760 MPCNL procedures were performed in 3 610 kidneys.Among all these cases,2 790 cases received MPCNL via a single tract and 820 cases via multiple tracts,with an average of 1.2 tracts per kidney.The average operative time was 78 minutes.The stone-free rate at postoperative day 2 was 89%.Significant complications occurred in 31 cases included 13 cases of severe bleeding,7 cases of pleural injury,9 cases of sepsis,one case of perinephric abscess and one patient died from myocardial infarction.Compared with standard PCNL,the rate of major complications of MPCNL was lower.Conclusions MPCNL is safe and effective for managing all kinds of upper-tract calculi.Compared with standard PCNL,our approach and technique of MPCNL can decrease the complication incidence and achieve good stone clearance.