斜仰截石位微创经皮肾镜联合输尿管镜治疗肾及输尿管结石的临床探讨

Clinical study on treatment of renal combined ureteral calculi with minimally invasive percutaneous nephrolithotomy(MPCNL)combined with ureteroscopic lithotomy(URSL)under a single position of oblique supine lithotomy

目的探讨斜仰截石位微创经皮肾镜或联合输尿管镜取石术治疗肾及输尿管结石的临床疗效。方法2015年10月至2018年10月我院收治48例同侧肾及输尿管结石患者,根据手术方式不同分为Ⅰ组与Ⅱ组,Ⅰ组患者(n=24)采取斜仰截石位微创经皮肾镜碎石取石术(MPCNL)联合输尿管镜碎石取石术(URSL)治疗,Ⅱ组患者(n=24)采取俯卧位MPCNL进行治疗,回顾性对比两组患者的治疗效果。结果两组患者手术时间、术中出血量、并发症发生率比较差异具有统计学意义(P<0.05);两组患者肾结石取石率、输尿管结石取石率、输血率比较差异无统计学意义(P>0.05)。两组患者心率(HR)、心输出量(CO)、每搏输出量(SV)、外周血管阻力(SVR)等指标比较差异无统计学意义(P>0.05),两组患者中心静脉压(CVP)及胸腔液体含量(TFC)指标变化比较差异有统计学意义(P<0.05)。结论斜仰截石位MPCNL联合URL治疗肾及输尿管结石具有一种体位即可同时微创处理肾及输尿管结石,安全性高、手术时间短、术中出血量少、术后并发症少等优势。

Objective To explore the clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy(MPCNL)and ureteroscopic lithotomy(URSL)in the treatment of renal combined ureteral calculi under a single position of oblique supine lithotomy.Methods From October 2015 to October 2018,48 patients suffered from renal calculi or combined ureteral calculi,were divided into two groups:groupⅠand groupⅡ.GroupⅠwere treated with MPCNL combined with URSL under a single position of oblique supine lithotomy.GroupⅡwere treated with PCNL in general prone position.The therapeutic effects were compared between the two groups retrospectively.Results The differences of operation time,blood loss and rate of complitation between the two groups were statistically significant(P<0.05).There was no difference in renal stone clearance rate,ureteral stone clearance rate and blood transfusion rate between the two groups(P>0.05).There was no significant difference in HR,CO,SV,SVR between the two groups(P>0.05),but there was significant difference in CVP and TFC between the two groups(P<005).Conclusion MPCNL combined with URSL in the treatment of renal calculi combined with ureteral calculi under a single position of oblique supine lithotomy has the advantages of high safety,shorter operation time,less blood loss,and fewer complications.