Objective:This study developed a novel technique for performing percutaneous nephrolithotomy(PCNL)in the knee-flexion prone split-leg(KF-PSL)position;this technique aimed to address the shortcomings of the traditional...Objective:This study developed a novel technique for performing percutaneous nephrolithotomy(PCNL)in the knee-flexion prone split-leg(KF-PSL)position;this technique aimed to address the shortcomings of the traditional prone(TP)position and the PSL position.The study evaluated the safety,advantages,and feasibility of the KF-PSL position compared to the TP position.Methods:A novel technique was developed based on the common PSL position.A retrospective analysis was conducted on the data of 276 patients who underwent PCNL in either the KF-PSL or TP position between January 2022 and June 2023.Demographic and perioperative clinical data of the KF-PSL and TP groups were reviewed and compared.Results:A total of 276 patients were divided into two groups based on the operative position.The preoperative parameters of the two groups did not differ significantly.The mean stone size(represented by the aggregation of the diameter of all the stones)was 40.03(SD 23.89)mm.Significant differences were found in both the mean operative time(80.9[SD 47.2]min in KF-PSL vs.107.3[SD 57.7]min in TP,p<0.001)and the stone-free rates(73% in KF-PSL vs.61% in TP,p=0.046).Braden Scale scores of the two groups did not differ significantly(p=0.12).No significant difference was observed between the groups in the total complication rate(p=0.6).Conclusion:The KF-PSL is a promising modified position for PCNL that allows for a shorter operative time,a higher stone-free rate,and a more simplified surgical procedure compared to the TP position without compromising outcomes.It is more convenient for combined therapy,allowing access to the entire urinary tract without the need for position changes.展开更多
Background:The goal of this study was to determine the safety and efficacy of endoscopic combined intrarenal surgery(ECIRS)performed in the prone split-leg position for the treatment of complex renal stones.Materials ...Background:The goal of this study was to determine the safety and efficacy of endoscopic combined intrarenal surgery(ECIRS)performed in the prone split-leg position for the treatment of complex renal stones.Materials and methods:A mature ECIRS protocol was designed.Retrospective analysis was conducted of medical records between January 2020 and December 2021 of patients with complex renal stones at one center who underwent ECIRS by 2 skilled surgeons using retrograde flexible ureteroscopy and mini-percutaneous nephrolithotomy in the prone split-leg position.Results:A total of 44 patients were included in this study.Mean stone size was 26.1±12.7 mm,and the number of calyces involved was 4.36±2.09.Mean operative time was 71.1±21.8 minutes.Postoperative decline in hemoglobin was 15.8±9.8 g/L.Seventy-five percent of patients achieved stone-free status.The mean number of residual stones was 2.8±2.3,and the mean residual stone size was 10.30±4.76 mm.Six patients(13.6%)developed postoperative complications,including 4 with fever during the first 2 days postoperatively and 2 patients with transient postoperative pain.No patients developed severe complications.Conclusions:Endoscopic combined intrarenal surgery in the prone split-leg position can be performed safely by experienced surgeons using retrograde flexible ureteroscopy in conjunction with mini-percutaneous nephrolithotomy as a successful technique for the treatment of complex renal stones.展开更多
目的系统评价分腿俯卧位经皮肾镜取石术(PCNL)的临床效果和安全性,探讨分腿俯卧位的可行性、有效性和优越性。方法计算机检索PubMed、Cochrane Library、Web of Science、CINAHL、Embase、OVID、中国知网、中国生物医学文献数据库、万...目的系统评价分腿俯卧位经皮肾镜取石术(PCNL)的临床效果和安全性,探讨分腿俯卧位的可行性、有效性和优越性。方法计算机检索PubMed、Cochrane Library、Web of Science、CINAHL、Embase、OVID、中国知网、中国生物医学文献数据库、万方数据库、维普数据库中关于分腿俯卧位PCNL的RCT及队列研究,检索时限为建库至2022年8月。按照纳入和排除标准筛选文献,并进行文献质量评价,采用RevMan 5.4软件进行Meta分析。结果Meta分析最终纳入14篇文献,共2477例患者。结果显示,相较于传统俯卧位PCNL,分腿俯卧位PCNL的手术时间[MD=-15.17(-20.47,-9.8),Z=21.23,P<0.01]及住院时间[MD=-1.06(-1.79,-0.32),Z=2.81,P<0.01]短,术中出血量[MD=-15.82(-30.39,-1.26),Z=2.13,P=0.03]及并发症发生率[M-H=0.72(0.57,0.91),Z=2.72,P=0.007]低;相较于斜仰卧位PCNL,分腿俯卧位PCNL所需手术时间短[MD=-23.02(-28.87,-18.17),Z=9.30,P<0.01],但并发症发生率高[M-H=1.78(1.23,2.58),Z=3.07,P=0.002]。而在皮肾通道建立时间[MD=-1.69(-5.58,2.21),Z=0.85,P=0.40]、结石清除率[M-H=1.07(1.00,1.15),Z=1.99,P=0.05]、再手术率[M-H=0.50(0.18,1.36),Z=1.36,P=0.17]方面,暂未发现分腿俯卧位较其他体位差异有统计意义。结论分腿俯卧位PCNL能缩短患者手术时间及住院时间,较传统俯卧位PCNL具有更低的并发症发生率。而在皮肾通道建立时间、结石清除率、再手术率方面与传统俯卧位PCNL相似。展开更多
基金funded by the Natural Science Foundation of Guangdong Province(2017A030313784 to Wu R and 2023A1515010413 to Zeng Q)Natural Science Foundation of Guangxi(2024JJA140617 to Zeng Q)Foundation of the Health Commission of Guangdong Province(2021-342 to Wu R).
文摘Objective:This study developed a novel technique for performing percutaneous nephrolithotomy(PCNL)in the knee-flexion prone split-leg(KF-PSL)position;this technique aimed to address the shortcomings of the traditional prone(TP)position and the PSL position.The study evaluated the safety,advantages,and feasibility of the KF-PSL position compared to the TP position.Methods:A novel technique was developed based on the common PSL position.A retrospective analysis was conducted on the data of 276 patients who underwent PCNL in either the KF-PSL or TP position between January 2022 and June 2023.Demographic and perioperative clinical data of the KF-PSL and TP groups were reviewed and compared.Results:A total of 276 patients were divided into two groups based on the operative position.The preoperative parameters of the two groups did not differ significantly.The mean stone size(represented by the aggregation of the diameter of all the stones)was 40.03(SD 23.89)mm.Significant differences were found in both the mean operative time(80.9[SD 47.2]min in KF-PSL vs.107.3[SD 57.7]min in TP,p<0.001)and the stone-free rates(73% in KF-PSL vs.61% in TP,p=0.046).Braden Scale scores of the two groups did not differ significantly(p=0.12).No significant difference was observed between the groups in the total complication rate(p=0.6).Conclusion:The KF-PSL is a promising modified position for PCNL that allows for a shorter operative time,a higher stone-free rate,and a more simplified surgical procedure compared to the TP position without compromising outcomes.It is more convenient for combined therapy,allowing access to the entire urinary tract without the need for position changes.
文摘Background:The goal of this study was to determine the safety and efficacy of endoscopic combined intrarenal surgery(ECIRS)performed in the prone split-leg position for the treatment of complex renal stones.Materials and methods:A mature ECIRS protocol was designed.Retrospective analysis was conducted of medical records between January 2020 and December 2021 of patients with complex renal stones at one center who underwent ECIRS by 2 skilled surgeons using retrograde flexible ureteroscopy and mini-percutaneous nephrolithotomy in the prone split-leg position.Results:A total of 44 patients were included in this study.Mean stone size was 26.1±12.7 mm,and the number of calyces involved was 4.36±2.09.Mean operative time was 71.1±21.8 minutes.Postoperative decline in hemoglobin was 15.8±9.8 g/L.Seventy-five percent of patients achieved stone-free status.The mean number of residual stones was 2.8±2.3,and the mean residual stone size was 10.30±4.76 mm.Six patients(13.6%)developed postoperative complications,including 4 with fever during the first 2 days postoperatively and 2 patients with transient postoperative pain.No patients developed severe complications.Conclusions:Endoscopic combined intrarenal surgery in the prone split-leg position can be performed safely by experienced surgeons using retrograde flexible ureteroscopy in conjunction with mini-percutaneous nephrolithotomy as a successful technique for the treatment of complex renal stones.
文摘目的系统评价分腿俯卧位经皮肾镜取石术(PCNL)的临床效果和安全性,探讨分腿俯卧位的可行性、有效性和优越性。方法计算机检索PubMed、Cochrane Library、Web of Science、CINAHL、Embase、OVID、中国知网、中国生物医学文献数据库、万方数据库、维普数据库中关于分腿俯卧位PCNL的RCT及队列研究,检索时限为建库至2022年8月。按照纳入和排除标准筛选文献,并进行文献质量评价,采用RevMan 5.4软件进行Meta分析。结果Meta分析最终纳入14篇文献,共2477例患者。结果显示,相较于传统俯卧位PCNL,分腿俯卧位PCNL的手术时间[MD=-15.17(-20.47,-9.8),Z=21.23,P<0.01]及住院时间[MD=-1.06(-1.79,-0.32),Z=2.81,P<0.01]短,术中出血量[MD=-15.82(-30.39,-1.26),Z=2.13,P=0.03]及并发症发生率[M-H=0.72(0.57,0.91),Z=2.72,P=0.007]低;相较于斜仰卧位PCNL,分腿俯卧位PCNL所需手术时间短[MD=-23.02(-28.87,-18.17),Z=9.30,P<0.01],但并发症发生率高[M-H=1.78(1.23,2.58),Z=3.07,P=0.002]。而在皮肾通道建立时间[MD=-1.69(-5.58,2.21),Z=0.85,P=0.40]、结石清除率[M-H=1.07(1.00,1.15),Z=1.99,P=0.05]、再手术率[M-H=0.50(0.18,1.36),Z=1.36,P=0.17]方面,暂未发现分腿俯卧位较其他体位差异有统计意义。结论分腿俯卧位PCNL能缩短患者手术时间及住院时间,较传统俯卧位PCNL具有更低的并发症发生率。而在皮肾通道建立时间、结石清除率、再手术率方面与传统俯卧位PCNL相似。
