俯卧分腿位一期经皮肾镜联合输尿管软镜治疗复杂性铸型结石的临床研究  

The clinical study of percutaneous nephrolithotomy combined with retrograde flexible ureteroseopic lithotripsy in the prone split-leg position for treating renal staghorn calculi

作　　者：卢国平[1] 廖科诚[1] 张志甫[1] Lu Guoping;Liao Kecheng;Zhang Zhifu(Department of Urology,Guangxi Minzu Hospital,Nanning 530001,China)

机构地区：[1]广西壮族自治区民族医院泌尿外科,南宁530001

出　　处：《中华腔镜泌尿外科杂志（电子版）》2020年第4期249-253,共5页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的探讨俯卧分腿位一期经皮肾镜(PCNL)联合逆行输尿管软镜(RIRS)治疗复杂性铸型结石的可行性、有效性和安全性。方法回顾性分析我院2015年8月至2019年8月93例复杂性铸型结石患者的临床资料,其中PCNL组50例仅行PCNL,PCNL+RIRS组43例一期行PCNL联合RIRS,术前肾结石情况采用S.T.O.N.E评分系统进行评估;两组均在截石位下置入输尿管支架管(剪去头端),PCNL组改为俯卧位,PCNL+RIRS组改为俯卧分腿位,比较两组的手术时间、术后血红蛋白下降值、术后发热率、再次手术率、结石清除率、术后住院天数及并发症。结果两组的术前基本资料差异无统计学意义,所有患者均顺利完成手术,PCNL+RIRS组需要建立的通道显著少于PCNL组;PCNL+RIRS组在血红蛋白下降值、结石清除率、再次手术率、平均住院天数上均明显优于PCNL组;虽然两组在手术时间、术后发热率、手术并发症差异无统计学意义,但是PCNL组有1例需要介入栓塞患者,并且PCNL组患者术后发热比例高于PCNL+RIRS组,差异无统计学意义可能与本研究例数较少有关。结论俯卧分腿位一期经皮肾镜联合逆行输尿管软镜治疗复杂性肾结石安全有效,可以减少穿刺通道和术中出血,提高结石清除率,降低再次手术率。Objective Investigate the feasibility,efficacy and safety of percutaneous nephrolithotomy(PCNL)combined with retrograde intrarenal surgery(RIRS)in the treatment of renal staghorn calculi in split-leg prone position.Methods The clinical data of 93 patients with renal staghorn calculi in our hospital from August 2015 to August 2019 were retrospectively analyzed.50 patients in the PCNL group received PCNL surgery only,and 43 patients in the PCNL+RIRS group received PCNL combined with RIRS surgery.The preoperative renal calculus was evaluated by the S.T.O.N.E scoring system.Both groups were inserted into the ureteral stents(getting rid of the head end)in the lithotomy position,then the PCNL group was changed to prone position for PCNL surgery,and the PCNL+RIRS group was changed to split-leg prone position.Operation time,postoperative hemoglobin decline,postoperative fever rate,reoperation rate,stone clearance rate,postoperative hospital stay and complications were compared between the two groups.Results There was no significant difference in preoperative basic data between the two groups.The procedure was successfully performed in all the patients,and the channels which were needed to be established in the PCNL+RIRS group were significantly less than that in the PCNL group.The PCNL+RIRS group have the advantage over the PCNL group in terms of decreased hemoglobin,stone clearance rate,reoperation rate and average hospital stay.Although there was no statistical difference in the operation time,postoperative fever rate and complications between the two groups,there was 1 patient in the PCNL group who needed embolization intervention because of bleeding.In addition,the ratio of postoperative fever in the PCNL group was higher than that in the PCNL+RIRS group,but no statistical difference was found.That may be attributed to the small number of cases in this study.Conclusions Percutaneous nephrolithotomy(PCNL)combined with retrograde intrarenal surgery(RIRS)in split-leg prone position is safe and effective for the treatmen

关 键 词：铸型结石 经皮肾镜 输尿管软镜 俯卧分腿位 双镜联合 

分 类 号：R699[医药卫生—泌尿科学]