侧卧体位下经皮肾穿刺取石术联合经尿道输尿管镜取石术治疗复杂上尿路结石的临床应用价值

The Clinical Value of Lateral Decubitus Percutaneous Nephrolithotomy Combined with Transurethral Ureteroscopic Lithotripsy for Treatment of Upper Urinary Tract Calculi

目的：探讨侧卧体位下经皮肾穿刺取石术联合经尿道输尿管镜取石术治疗复杂上尿路结石的可行性及临床应用价值。方法：回顾性分析2009年8月至2011年9月我院采用侧卧体住下经皮肾穿刺取石术联合经尿道输尿管镜取石术治疗复杂上尿路结石患者52例的临床资料：患者同时存在肾脏铸型结石或多发结石和或输尿管上段结石，单个结石最大径8-30mm。结果：平均手术时间60分钟（50—120分钟）；术前血红蛋白116±30g／L，术后第一天复查105±26g／L，无大出血需要输血病例；一次结石取净率为86．5％（45／52），总取净率为92．3％（48／52）。结论：侧卧体位下经皮肾穿刺取石术及经尿道输尿管镜取石术两种术式联合应用具有可行性及互补性，在预防及减少术中出血、获得清晰的手术视野、减少灌注液外渗、增加结石清除速度及碎石成功率、缩短手术时间、减少术后发热等方面疗效显著，为治疗复杂上尿路结石提供了一个可行的新方法。

Objective： To investigate the feasibility and clinical value of the lateral position percutaneous nephrolithotomy combined with transurethral ureteroscopic lithotripsy for treatment of upper urinary tract calculk Methods：We retrospectively reviewed the data of 52 patient, who suffer from complicated urinary tract stones and were treated by lateral decubitus percutaneous nephrolithotomy combined transurethral ureteroscopic lithotripsy from August 2009 to September 2011 in our hospital. All patients have simultaneously kidney cast stone or multiple stones and or ureteral calculi, with 8 - 30 mm of the largest single stone diameter. Results： The mean operation time was 60 minutes （50-120 minutes）. No massive haemorrhage occurred and no blood transfusion was necessary. The average blood haemoglobin concentration was 116± 30 g/L before operation and 105± 26 g/L the first day after operation. The single operation stone clearance rate was 86.5 % （45/52） and totally 92.3 %（48/52）. Conclusion：It is feasible and complementary to com- bine percutaneous nephrolithotomy with transurethral ureteroscopic lithotripsy by lateral position. It has a significant effect reducing blood loss, obtaining a clear surgical field, reducing the infusion fluid extravasation, increasing the speed, improving stone clearance success rate, and shortening the operation time. That provided a feasible new method for the treatment of complicated upper urinary tract calculi.