斜仰卧-截石位双镜联合治疗复杂性肾结石的临床研究

Clinical study on combined endoscopy in oblique supine lithotomy position in treatment of complex renal calculi

目的:研究斜仰卧-截石位双镜联合(肾镜联合顺-逆行输尿管软镜)治疗复杂性肾结石的疗效和安全性。方法:回顾性分析我院使用斜仰卧-截石位双镜联合治疗的76例复杂性肾结石患者资料,观察碎石、取石效果。结果:69例患者一期手术中双镜联合治疗肾结石(69例均使用顺行输尿管软镜碎石,其中23例顺行输尿管软镜碎石后同期逆行输尿管软镜治疗残留结石),7例二期手术中双镜联合治疗结石。一期手术时间65~133min,平均(95.66±15.21)min,结石清除率为90.7%(69/76);二期手术时间55~106min,平均(73.26±11.33)min,结石清除率96.1%(73/76)。3例患者二期手术后仍有残留结石,术后1个月行体外冲击波碎石术(ESWL)治疗,1例结石完全排出,2例残留结石直径大小0.6~0.9cm。结论:斜仰卧-截石位双镜联合治疗复杂性肾结石安全、迅速,一期手术结石清除率高,患者术后恢复快,是一种安全有效的治疗复杂性肾结石的方法。

Objective：To investigate the safety and effect of combined endoscopy（standard-access percutaneous nephrolithotomy in oblique supine lithotomy position combined with prograde or retrograde flexible ureteroscopy）in treatment of complex renal calculi.Method：We observed the curative effect from retrospective analysis data of 76 patients with complex renal calculi in our department who were treated by oblique supine combined endoscopy.Result：Sixty-nine cases treated with PCNL combined with prograde flexible ureteroscopy in first-stage operation,including 23 cases with retrograde flexible ureteroscopy at the same time.Seven cases treated with PCNL combined with flexible ureteroscopy in second-stage operation.The time of first-stage operation ranged from65 to 133 min（average,95.66±15.21 min）,stone clearance rate was 90.7%（69/76）,The time of second-stage was from 55 to 106 min（average,73.26±11.33 min）,stone clearance rate was 96.1%（73/76）.Three cases had remained stone after second-stage operation.Residual calculus of one case was removed completely by ESWL one month later,and the diameter of residual calculus of the two cases was 0.6-0.9 cm.Conclusion：Combined endoscopy in oblique supine lithotomy position is a safe and effective operation method with high stone clearance rate and quick recovery for complex renal calculi.