Peng Chen, Tony Tzu-Chun Wei, Eric Yi-Hsiu Huang, Tzu-Ping Lin, Tzu-Hao Huang, Chih-Chieh Lin, I-Shen Huang, William J Huang
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引用次数: 1
Abstract
Background: The management of urolithiasis in the kidney has been drastically changed in the era of endourology, mainly consisting of three surgical procedures: extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). Since ESWL is usually less invasive via ambulatory clinic routes, this study aimed to examine the stone-free rate (SFR) between PCNL and RIRS.
Methods: We retrospectively reviewed patients who had renal stones and were treated with either PCNL or RIRS from June 2016 to June 2018. Staghorn stones, stones with diameters <1 cm, and stones with diameters >2 cm were excluded. Patients who underwent multiple surgeries for bilateral renal stones and those with graft kidney stones were excluded from the study. X-ray, sonography, and/or computed tomography (CT) were used to calculate the size of the stones. Follow-up was evaluated by the same image examination within three months after surgery. Stone-free was defined as no residual stone or the presence of asymptomatic calculi <4 mm. The operation time was defined as a skin-to-skin interval.
Results: Following exclusion criteria, there were 39 patients in each arm, with no difference in age, sex, or any other demographic data. The average stone size in the PCNL and RIRS groups was 16.3 and 14.0 mm, respectively ( p = 0.009). There was no significant difference in SFR (71.8% vs 61.5%, p = 0.337); the operation time was significant longer ( p < 0.001), and the hospital stay was significantly shorter ( p < 0.001) in the RIRS group.
Conclusion: PCNL and RIRS are both feasible options for managing kidney stones. However, the initial stone size might affect the selection of operation. The SFR in the PCNL group was numerically but not statistically higher. The RIRS group, on the other hand, had a longer operation time but a shorter hospital stays.
背景:肾内尿石症的治疗在泌尿内镜时代发生了巨大的变化,主要包括三种手术方法:体外冲击波碎石术(ESWL)、经皮肾镜取石术(PCNL)和逆行肾内手术(RIRS)。由于ESWL通常通过门诊途径侵入性较小,因此本研究旨在检查PCNL和RIRS之间的无石率(SFR)。方法:我们回顾性分析了2016年6月至2018年6月期间接受PCNL或RIRS治疗的肾结石患者。排除鹿角石、直径2 cm的结石。接受多次手术治疗双侧肾结石和移植肾结石的患者被排除在研究之外。x光、超声和/或计算机断层扫描(CT)被用来计算结石的大小。术后3个月内行相同影像学检查随访。无结石定义为无残留结石或无症状结石的存在。结果:根据排除标准,每组有39例患者,年龄、性别或任何其他人口统计学数据没有差异。PCNL组和RIRS组的平均结石大小分别为16.3和14.0 mm (p = 0.009)。SFR差异无统计学意义(71.8% vs 61.5%, p = 0.337);RIRS组手术时间显著延长(p < 0.001),住院时间显著缩短(p < 0.001)。结论:PCNL和RIRS都是治疗肾结石的可行选择。但是,最初的石材尺寸可能会影响操作的选择。PCNL组的SFR在数值上高于PCNL组,但无统计学意义。另一方面,RIRS组手术时间较长,但住院时间较短。
期刊介绍:
Journal of the Chinese Medical Association, previously known as the Chinese Medical Journal (Taipei), has a long history of publishing scientific papers and has continuously made substantial contribution in the understanding and progress of a broad range of biomedical sciences. It is published monthly by Wolters Kluwer Health and indexed in Science Citation Index Expanded (SCIE), MEDLINE®, Index Medicus, EMBASE, CAB Abstracts, Sociedad Iberoamericana de Informacion Cientifica (SIIC) Data Bases, ScienceDirect, Scopus and Global Health.
JCMA is the official and open access journal of the Chinese Medical Association, Taipei, Taiwan, Republic of China and is an international forum for scholarly reports in medicine, surgery, dentistry and basic research in biomedical science. As a vehicle of communication and education among physicians and scientists, the journal is open to the use of diverse methodological approaches. Reports of professional practice will need to demonstrate academic robustness and scientific rigor. Outstanding scholars are invited to give their update reviews on the perspectives of the evidence-based science in the related research field. Article types accepted include review articles, original articles, case reports, brief communications and letters to the editor