单通道微创经皮肾镜碎石取石术联合输尿管软镜碎石取石术在斜仰卧截石位下治疗鹿角形结石的临床分析  

Combined single-tract of minimally percutaneous nephrolithotomy and flexible ureteroscopy for staghorn calculi in oblique supine lithotomy position

作　　者：李天[1] 许可慰[2] 谢清灵[1] 江先汉[1] 李逊[1] 赵风进 刘一帆[1] 殷羽飞[1] 黄奕桥 LI Tian;XU Kewei;XIE Qingling;JIANG Xianhan;LI Xun;ZHAO Fengjin;LIU Yifan;YIN Yufei;HUANG Yiqiao(Department of Urology Surgery,the Fifth Affiliated Hospital of 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,广州510700 [2]中山大学孙逸仙纪念医院泌尿外科,广州510700

出　　处：《实用医学杂志》2019年第12期2025-2028,共4页The Journal of Practical Medicine

基　　金：广东省医学科学技术研究基金立项资助项目(编号:A2017469)

摘　　要：目的探讨单通道微创经皮肾镜碎石取石术(MPCNL)联合输尿管软镜碎石取石术(FURS),在斜仰卧截石位下,治疗肾鹿角形结石(SC)的可行性、安全性及有效性。方法对87例2015年8月至2017年8月于我院泌尿外科行手术治疗的鹿角形结石患者进行回顾性分析。87例患者依据手术方式不同分为:MPCNL与FURS联合组(n=44)及MPCNL对照组(n=43)。将两组的结石清除率、围手术期参数、术后并发症进行分析、比较。结果两组在年龄、性别、结石类型及大小上差异无统计学意义(P> 0.05)。在手术平均时间亦差异有统计学意义(P <0.05)。在术后平均住院时间、血红蛋白水平、并发症发生率上,联合组均优于MPCNL组(P <0.05)。联合组首次术后结石清除率及辅助体外冲击波碎石术(ESWL)后结石清除率均高于MPCNL组,差异具有统计学意义(P <0.05)。结论利用MPCNL联合FURS治疗鹿角形结石,可提高手术的结石清除率,同时缩短手术与住院时间,降低术后并发症的发生及出血风险。在斜仰卧截石位状态下,利用MPCNL联合FURL治疗鹿角形结石是一种安全、有效的手术方式。Objective To provide a new feasible treatment for staghorn calculi(SC). And evaluate the the safety,efficiency of this approach of which combined single-percutaneous tract minimally invasive percutaneous nephrolithotomy(MPCNL) and flexible ureteroscopic lithotripsy(FURS) in oblique supine lithotomy position.Methods Eighty-seven patients with SC treated with surgery in our hospital from August 2015 to August 2017 were retrospectively analyzed. The 87 patients were distributed to 2 groups accounted for the operative type:MPCNL combined with FURS(Combined group,n = 44)and MPCNL(Control group,n = 43). The demography,perioperative parameters,and postoperative complications of the 2 groups were compared and analyzed. Results There were no significant diversity in age,gender,stone type,and calculi size(P > 0.05)between combined group and control group. There were no significant diversity in the average operative time between two groups(P <0.05). The average hospitalization time after surgery,the hemoglobin level,and the complication rate of combined group were lower than that of control group(P < 0.05). The primal and complementary stone free rates of combined group were both higher than that of control group(P < 0.05). Conclusion Single-tract MPCNL combined with FURS in the oblique supine lithotomy position to treat SC could improve stone free rates,reduce operative time and diminish length of hospital stay,decrease renal hemorrhage,and avoid adverse complications. It is an efficient and safe operative method to treat SC.

关 键 词：鹿角形结石 斜仰卧截石位 微创经皮肾镜碎石取石术 输尿管软镜碎石取石术 联合治疗 

分 类 号：R699.2[医药卫生—泌尿科学]