2-4厘米肾结石的治疗:多中心经验。经皮肾取石术和逆行肾内手术的安全性、疗效和成本比较。

IF 1.4 Q3 UROLOGY & NEPHROLOGY
Central European Journal of Urology Pub Date : 2023-01-01 Epub Date: 2023-04-07 DOI:10.5173/ceju.2023.119
Nicolò Fiorello, Andrea Di Benedetto, Andrea Mogorovich, Daniele Summonti, Massimo Aquilini, Giuseppe Silvestri, Chiara Gilli, Gregorio Romei, Michele Santarsieri, Francesca Manassero, Giorgio Pomara, Sandro Benvenuti, Carlo Alberto Sepich
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引用次数: 0

摘要

引言:本研究的目的是通过肾内逆行手术(RIRS)和经皮肾取石术(PCNL)治疗2-4 cm肾结石的无结石率(SFR)和成本来比较其安全性和有效性。材料和方法:我们分析了2019年1月至2021年12月期间在3个肾结石参考中心进行的RIRS和PCNL的相关数据。手术总数为130例(63例RIRS和67例PCNL)。结果:第1组RIRS持续时间为90分钟,第2组为115分钟,PCNL持续时间为135分钟,第二组为145分钟。RIRS持续时间较短,在第1组中有显著差异(p=0.0000114)。RIRS的SFR在第1和第2组分别为78%和21%,PCNL在第1、第2组中分别为92%和81%。因此,存在统计学上的显著差异,这在3cm和多发结石中更为明显(第1组p=0.0057,第2组p=0.0000146)。费用差异是通过计算单个手术的预期费用和普通住院的估计每日费用来估计的。结论:RIRS和PCNL可以安全地治疗2-4 cm的结石,但RIRS不应被选为大于3 cm的结石的选择,除非在选定的病例中。PCNL仍然是治疗复杂结石的金标准,尤其是对于大于3cm的结石。PCNL术后并发症的风险更高,即使这种差异不大。与RIRS相关的成本,即使在重新计算新治疗的需求时,仍然更便宜。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Treatment of 2-4 cm kidney stones: multicentre experience. Comparison of safety, efficacy, and costs of percutaneous nephrolithotomy and retrograde intrarenal surgery.

Treatment of 2-4 cm kidney stones: multicentre experience. Comparison of safety, efficacy, and costs of percutaneous nephrolithotomy and retrograde intrarenal surgery.

Treatment of 2-4 cm kidney stones: multicentre experience. Comparison of safety, efficacy, and costs of percutaneous nephrolithotomy and retrograde intrarenal surgery.

Treatment of 2-4 cm kidney stones: multicentre experience. Comparison of safety, efficacy, and costs of percutaneous nephrolithotomy and retrograde intrarenal surgery.

Introduction: The objective of this study is to compare the safety and efficacy, through the stone-free rate (SFR), as well as the costs, between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), for 2-4 cm kidney stones.

Material and methods: We analysed the data relating to RIRS and PCNL performed in 3 reference centres for kidney stones, in the period between 1/2019 and 12/2021. The total number of procedures was 130 (63 RIRS and 67 PCNL). We defined SFR as the absence of lithiasic fragments or stones <3 mm. Results were compared between 2 groups depending on the stone size: 2-3 cm stones (group 1) and >3 cm stones (group 2).

Results: The duration of RIRS was 90 minutes for group 1 and 115 minutes for group 2, and for PCNL it was 135 minutes for group 1 and 145 minutes for group 2. RIRS had shorter duration with a significant difference in group 1 (p = 0.000014). SFR for RIRS was 78% for group 1 and 21% for group 2, and for PCNL it was 92% for group 1 and 81% for group 2. Therefore, there is a statistically significant difference, which is more evident for 3 cm and multiple stones (p = 0.0057 for group 1, p = 0.000146 for group 2). The difference in costs was estimated by calculating the expected costs for a single surgical procedure and the estimated cost per day for ordinary hospitalization.

Conclusions: 2-4 cm stones can be safely treated with both RIRS and PCNL, but RIRS should not be chosen as an option for stones >3 cm, except in selected cases. PCNL remains the gold standard for the treatment of complex stones, especially for stones >3 cm. Risk of postoperative complications is higher in PCNL, even if this difference is not great. The costs associated with RIRS, even when recalculating with the need for new treatments, remain cheaper.

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来源期刊
Central European Journal of Urology
Central European Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
2.30
自引率
8.30%
发文量
48
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