完全侧卧位内镜肾内联合手术治疗鹿角形肾结石的临床价值

Clinical value of complete lateral position endoscopic combined intra-renal surgery in treatment of staghorn kidney calculi

目的评估完全侧卧位内镜肾内联合手术(ECIRS)治疗鹿角形肾结石的安全性和可行性。方法回顾性分析山西医科大学第一医院2016年3月至2022年7月105例鹿角形肾结石患者的临床资料。其中,55例患者采用侧卧位经皮肾镜取石术(PCNL)治疗(PCNL组),50例患者采用完全侧卧位ECIRS治疗(ECIRS组)。比较两组手术时间、拔除双J管时间、术后住院时间、术后血红蛋白下降值、手术并发症(采用Clavien-Dindo分级标准)、术后额外干预情况和结石清除率等。结果两组患者均顺利完成手术。ECIRS组手术时间、术后血红蛋白下降值和术后额外干预率明显小于PCNL组[(98.3±19.1)min比(103.4±16.5)min、(9.34±3.04)g/L比(12.55±4.75)g/L和8.00%(4/50)比21.82%(12/55)],结石清除率明显高于PCNL组[90.00%(45/50)比74.55%(41/55)],差异有统计学意义(P<0.05或<0.01);两组拔除双J管时间、术后住院时间、Clavien-Dindo≥Ⅱ级手术并发症发生率比较差异无统计学意义(P>0.05)。结论完全侧卧位ECIRS治疗鹿角形肾结石安全,疗效显著,具有一期结石清除率高、并发症发生率低和易于推广等特点,是ECIRS技术的良好补充。

Objective To assess the safety and feasibility of complete lateral position endoscopic combined intra-renal surgery(ECIRS)in treatment of staghorn kidney calculi.Methods The clinical data of 105 patients with staghorn kidney calculi from March 2016 to July 2022 in the First Hospital of Shanxi Medical University were retrospectively analyzed.Among them,55 patients were treated with lateral position percutaneous nephrolithotomy(PCNL)(PCNL group),and 50 patients were treated with complete lateral position ECIRS(ECIRS group).The operative time,removal time of double J-tube,postoperative hospital stay,postoperative hemoglobin decrease value,operative complications(using Clavien-Dindo grading criteria),additional postoperative intervention and calculi free rate were compared between two groups.Results Both groups of patients were successfully operated.The operative time,postoperative hemoglobin decrease value and rate of additional postoperative intervention in ECIRS group were significantly lower than those in PCNL group:(98.3±19.1)min vs.(103.4±16.5)min,(9.34±3.04)g/L vs.(12.55±4.75)g/L and 8.00%(4/50)vs.21.82%(12/55),the calculi free rate was significantly higher than that in PCNL group:90.00%(45/50)vs.74.55%(41/55),and there were no statistical differences(P<0.05 or<0.01);there were no statistical differences in the removal time of double J-tube,postoperative hospital stay,incidence of Clavien-Dindo≥gradeⅡoperative complications between two groups(P>0.05).Conclusion The complete lateral position ECIRS is a safe and effective treatment for staghorn kidney calculi,and is a good complement to the ECIRS technique because of its high stone free rate in phaseⅠ,low complication incidence and easy dissemination.