皮肤穿神经石切除 vs 尿路透镜治疗儿童结石
Jonathan S Ellison1, David I Chu2, Caleb P Nelson3
1Department of Urology, Medical College of Wisconsin, Milwaukee.
JAMA network open
|June 20, 2025
概括
皮肤透神经切除术 (PCNL) 和尿道镜检查 (URS) 对儿科结石的石头清除效果类似. PCNL显示出更好的患者报告结果和15毫米以上的石头的优越清除.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 儿科手术 儿科手术
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 临床指导方针推通过皮肤进行结石切除术 (PCNL) 或冲击波结石切除术,用于儿童结石≥20毫米.
- 尿道透视 (URS) 目前在现有指南中没有提到作为替代方案.
- 需要对PCNL与URS对儿科脏和尿道结石进行比较分析.
研究的目的:
- 在患有和/或尿路结石的儿童和青少年中,比较PCNL和URS之间的临床和患者报告结果.
- 评估与每个手术程序相关的疗效和患者经验.
主要方法:
- 一项前性队列研究,涉及美国和加拿大的31个医疗中心的1039名年龄在8至21岁的患者.
- 患者在2020年3月至2023年7月期间接受了PCNL或URS治疗脏和/或尿路结石.
- 石头清除在手术后6周通过超声波评估;患者报告的结果 (疼痛,焦虑,尿道症状) 在手术后1周收集.
主要成果:
- 在PCNL (67.2%) 和URS (73.4%) 之间,整体石头清除率相似,没有统计学上显著的差异.
- 对于大于15毫米的石头,PCNL与URS (55.0%) 相比,实现了明显更高的石头清除率 (94.0%).
- 与URS相比,PCNL表现出明显更好的患者报告结果,包括较低的疼痛强度,较少的疼痛干扰,减少焦虑,较少的心理压力经历,改善睡眠和较少的尿路症状.
结论:
- 穿皮腎石切除術 (PCNL) 提供與兒童腎石尿道鏡法 (URS) 相當的石頭清除,並提供優越的患者報告的結果.
- 对于超过15毫米的儿科结石,PCNL与更大的石头清除有关.
- 建议进一步进行具有足够功率的前性临床试验,以验证这些发现.
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