完全平卧位逆行输尿管软镜碎石术治疗上尿路结石的临床研究  

Research of retrograde intrarenal surgery in treatment of upper urinary tract calculi in completely supine position

作　　者：汤井源 金振华 张扬[1] 马隆[1] 丛小明[1] 张鑫[1] 李柳林 徐彦[1] TANG Jingyuan;JIN Zhenhua;ZHANG Yang;MA Long;CONG Xiaoming;ZHANG Xin;LI Liulin;XU Yan(Department of Urology,Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,210029,China)

机构地区：[1]江苏省中医院南京中医药大学附属医院泌尿外科,南京210029

出　　处：《临床泌尿外科杂志》2023年第6期424-427,共4页Journal of Clinical Urology

基　　金：江苏省中医院科主任学术提升专项(No:Y2021ZR21);国家自然科学基金青年科学基金项目(No:81902570)。

摘　　要：目的探讨完全平卧位下行逆行输尿管软镜碎石术(retrograde intrarenal surgery,RIRS)治疗上尿路结石的有效性及安全性。方法回顾性分析2014年7月—2021年12月在江苏省中医院泌尿外科完成的41例完全平卧位下RIRS的上尿路结石患者的临床资料,作为观察组。同时选取24例同期采用截石位RIRS手术的患者作为对照组。比较2组住院时间、手术时间、结石清除率、术前及术后24 h内D-二聚体水平以及术后并发症发生率的差异。结果2组患者在手术时间、住院时间、结石清除率、术后并发症方面差异均无统计学意义(P>0.05)。但观察组患者术后24 h内D-二聚体水平显著低于对照组,并且术后双下肢舒适度显著高于对照组,差异有统计学意义(P<0.05)。结论对于高龄、结石负荷大预计手术时间较长或者截石位摆放困难的患者,选择完全平卧体位完成RIRS是安全有效的。Objective To investigate the efficacy and safety of retrograde intrarenal surgery(RIRS)in treatment of upper urinary tract calculi in completely supine position.Methods Clinical data of 41 patients with upper urinary tract calculi who underwent RIRS in the completely supine position between July 2014 and December 2021 were retrospectively analyzed as the observation group.Other 24 patients who underwent RIRS in the lithotomy position during the same period were also selected as the control group.The hospitalization time,operation time,stone clearance rate,D-Dimer level and postoperative complication rate of the two groups were compared.Results There was no statistical difference between the two groups in terms of operative time,hospital stay,stone clearance rate or postoperative complications(P>0.05).However,the postoperative D-Dimer level of patients in the observation group was significantly lower than that of the control group,and the postoperative comfort level of lower limbs was significantly higher in the observation group than that in the control group(P<0.05).Conclusion It is safe and effective to directly choose the supine position to complete RIRS surgery for patients who are elderly,have a large stone size or have difficulty in placing lithotomy position.

关 键 词：完全平卧位 输尿管软镜 上尿路结石 

分 类 号：R693[医药卫生—泌尿科学]