俯卧人字位微创经皮肾镜联合输尿管软镜处理肾鹿角状结石  

Minimally endoscopic combined intrarenal surgery for staghorn calculi in prone split-leg position

作　　者：赖德辉[1,2] 李逊[1,2] 何永忠[1,2] 李天[1,2] 徐桂彬[1,2] 杨炜青[1,2] LAI De hui LI Nun HE Yong zhong LI Tian XU Gui-bin YANG Wei-qing(Department of Urology, the Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 510700 Minimally Invasive Technique and Product Translational Center, Guangzhou Medical University, Guangzhou 510700, China)

机构地区：[1]广州医科大学附属第五医院泌尿外科,广东广州510700 [2]广州医科大学微创外科技术和产品转化中心,广东广州510700

出　　处：《现代泌尿外科杂志》2017年第6期440-443,共4页Journal of Modern Urology

基　　金：广东省临床教学基地教学改革研究项目(No.2015JDB085);广州市教育系统创新团队项目(No.BC10);广东省教育厅青年创新人才项目(No.2016KQNCX133)

摘　　要：目的俯卧人字位微创经皮肾镜联合输尿管软镜(MECIS)治疗肾鹿角状结石的临床应用价值。方法回顾性分析我院2016年5至8月俯卧人字位MECIS治疗肾鹿角状结石的30例患者的临床资料。平均年龄(42.4±10.9)岁,男/女比10/20。体重指数(BMI)23.1~30.1。左/右比12/18,结石最大直径3.4~5.4cm。结果所有患者均在该体位下,采用单F20经皮肾镜结合输尿管软镜完成手术,平均手术时间(116±9.83)min。术后结石清除率(SFR)83.3%;5例结石残留,其中2例行二期微创经皮肾镜取石术(mPCNL),1例行体外冲击波碎石术(ESWL),2例临床随访。术后1月SFR87%。术中无肠道损伤、感染性休克等并发症,术后1例输血,3例发热,保守处理治愈。结论俯卧人字位微创经皮肾镜联合输尿管软镜治疗肾鹿角型结石,技术可行,结石清除率高,能有效减少穿刺通道和降低并发症率。软镜操作者体位舒适,经皮肾镜操作者对体位熟悉,俯卧人字位是操作两镜联合的理想体位。Objective To evaluate the clinical value of minimally endoscopic combined intrarenal surgery（MECIS）in the prone split-leg position in managing the staghorn calculi.Methods The clinical data of 30 patients（10 males and 20 females）with staghorn calculi who underwent MECIS in prone split-leg position during May and August 2016 were retrospectively analyzed.The patients＇mean age was（42.4±10.9）years,the body mass index（BMI）was 23.1~30.1 kg/m^2,and the diameter of stones was 3.4~5.4 cm.Results All procedures were performed successfully with a F20 single tract.The mean operation time was（116±9.83）min.The initial stone-free rate（SFR）was 83.3%,and the final SFR was 87%.Residual stones were observed in5 patients,1 of whom received extracorporeal shock wave lithotripsy（ESWL）,2 received minimally invasive percutaneous nephrolithotomy（mPCNL）and 2 were followed up.No complications such as intestinal injury or septic shock occurred during operation.One patient required blood transfusion,and 3 patients had postoperative fever.All recovered after conservative treatment.The SFR was 87% 1 month after operation.Conclusions MECIS in the prone split-leg position is a viable approach for staghorn calculi,with high SRF and low complication rate.Doctors who perform mPCNL are familiar with this position.This position is the ideal position for MECIS.

关 键 词：俯卧人字位 鹿角状结石 两镜联合 

分 类 号：R692.4[医药卫生—泌尿科学]