穿皮瘤切除术后的残留碎片:是否必须对所有碎片进行治疗?
Andrea Li Puma1, Federica Passarelli1, Elisa De Lorenzis1,2
1Department of Urology, IRCCS Fondazione Ca' Granda, Policlinico di Milano, Milan, Italy.
Urolithiasis
|June 4, 2025
概括
根据大小,微型皮穿性瘤切除术 (mPCNL) 后的残留碎片 (RF) 的影响结果不同. 中等射频 (6-9毫米) 增加了急诊室的访问,而小射频 (≤5毫米) 容易生长,但往往保持无症状.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 腎石病的管理方法
- 最少侵入性的手术
背景情况:
- 微型皮穿性利切除术 (mPCNL) 后的残留碎片 (RF) 可以影响患者的结果.
- 了解射频尺寸的影响对于优化术后管理和患者随访至关重要.
研究的目的:
- 根据miniPCNL (mPCNL) 后的残留碎片 (RF) 大小,调查并发症率,石头生长和通过.
- 确定不同射频大小的临床意义,以指导治疗决策.
主要方法:
- 对接受mPCNL的572名患者的回顾性分析,确定了105名RF和至少1年的随访.
- 射频被分为≤5毫米,6-9毫米和≥10毫米的分层.
- 包括后勤回归在内的统计分析被用来评估射频大小和与石头有关的事件之间的关联.
主要成果:
- 患有6-9毫米射频的患者与其他组相比 (36.1%) 患急诊室住院的风险更高 (p=0.01).
- 较小的RF (≤5毫米) 显示石头生长率较高 (37.0%) (p=0.02).
- 多变量分析表明,对于6-9毫米的射频,与石头有关的事件的风险增加了5.5倍,对于≤5毫米的射频,石头生长的风险增加了9.6倍.
结论:
- 其余碎片大小显著影响mPCNL后的临床结果.
- 由于急诊室访问的风险增加,中等尺寸的RF (6-9毫米) 需要立即治疗.
- 小型射频 (≤5毫米) 可以通过保守或延迟干预来管理,因为它们不太可能引起立即并发症,但随着时间的推移,它们可能会生长.
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