斜仰截石位经皮肾镜主导双镜联合同期治疗上尿路结石的初步经验

The preliminary experience in management of upper urinary tract calculi with percutaneous nephrolithotomy combined ureteroscope lithotripsy under recumbency lithotomy position

目的探讨斜仰截石位下以经皮肾镜为主导联合输尿管镜双镜技术同期治疗上尿路结石的疗效及安全性。方法回顾性分析2014年7月至2016年3月间122例上尿路结石患者手术治疗的临床资料。根据手术方式分为两组:双镜组58例,采用斜仰截石位一期经皮肾镜为主导联合输尿管镜双镜技术进行治疗;传统组64例,常规俯卧位经皮肾镜碎石取石术。比较两组的手术时间、一期清石率、住院时间、围术期并发症等。结果所有手术均顺利完成,1例改开放手术治疗,围术期无一例死亡。双镜组和传统组的平均手术时间分别为87(40)min,90(44)min;一期清石率分别为95%,78%;住院时间分别为5(0)d,5(4)d;总的并发症(出血栓塞、感染性休克、其他脏器损伤)发生率分别为3例(5%)、9例(12%)。结论斜仰截石位同期双镜联合技术能明显提高上尿路结石的一期碎石清石率,在铸型结石、多发结石、合并肾内感染性结石等治疗方面有明显优势。

Objective To explore the efficacy and safety ofpercutaneous nephrolithotomy combined ureteroscope lithotripsy under recumbency lithotomy position in the treatment of upper urinary tract calculi.Methods Between July 2014 and March 2016, Clinical data of 122 patients with upper urinary tract calculi were analyzed retrospectively. According to the operative method, the patients were divided into two groups. The combined group included 58 cases with percutaneous nephrolithotomy combined ureteroscope lithotripsy under recumbency lithotomy position. The traditional operation group was composed of 64 cases with percutaneous nephrolithotomy under prone position. The operation time, the first phase of the stone free rate, hospital stay and perioperative complications were compared. Results All the operations were performed successfully. Of them, I case was converted to open surgery. No patient died during perioperative period. The average operation time was 87（40） minutes and 90（44） minutes, the first phase stone removal rate was 95% and 78%, the length of hospital stay was 5（0） days and 5（4） days, the total operation complications （bleeding embolism, septic shock and other organ injury） rates were 3 case （5%） and 9 case （12%） in the combined group and the traditional operation group, respectively. Conclusion Percutaneous nephrolithotomy combined ureteroscope lithotripsy under recumbency lithotomy position could improve the first phase stone removal rate for upper urinary tract calculi, and especially have advantages for staghorn calculi, multiple calculi, and renal calculi with infection.