斜仰卧位下双镜联合治疗复杂性肾结石

Semi supine position endoscopic combined intrarenal surgery for complex kidney stones

目的探讨斜仰卧位下双镜联合治疗复杂性肾结石的有效性及安全性。方法回顾性分析2016年10月-2019年10月该院收治的112例复杂性肾结石患者的临床资料,均采用斜仰卧位下单通道经皮肾镜与输尿管软镜双镜联合治疗。于B超定位下穿刺建立经皮肾通道,采用经皮肾镜处理复杂性结石的主体,再通过输尿管软镜与经皮肾镜形成的视野互补,处理各肾盏残留结石。术后复查CT,评估结石清除率。结果所有患者均顺利完成手术,无休克和死亡等严重并发症发生。手术时间(45.5±12.7)min,住院天数(7.3±2.1)d。术后5例接受输血治疗,12例出现发热,10例出现结石残留,结石清除率为91.1%。结论斜仰卧位下单通道经皮肾镜联合输尿管软镜能有效提高复杂性肾结石的治疗效果,降低手术风险,可成为复杂性肾结石的重要治疗手段。

Objective To explore the utility and safety effect on complex kidney stones treatment by semi supine position endoscopic combined intrarenal surgery.Methods We retrospectively analyzed the clinical data of 112 patients of complex kidney stones who underwent the semi supine position endoscopic combined intrarenal surgery with flexible ureteroscopy and percutaneous nephrolithotomy(PCNL)from Oct 2016 to 2019.Single percutaneous tract was established by B-ultrasound positioning,and the main part of the stone were treated by PCNL.Then,flexible ureteroscopy was put in the renal collecting system and completed the lithotripsy.Patients need to accept the CT examination again to check the stone-free rates.Result 112 cases were completed well without any shock or death complication.The surgery duration was(45.5±12.7)min and hospitalization time was(7.3±2.1)d.After the surgery,5 patients accepted blood transfusion and 12 patients had a fever.10 patients were examined with retained stones with the stone-free rate of 91.1%at last.Conclusion By the semi supine position endoscopic combined intrarenal surgery,a complementary parallel-tract treatment was established effectively improve the complex kidney stones treatment result,which can be explored deeper and promoted wider.