斜仰卧截石位下I期双镜联合与单通道经皮肾镜治疗复杂性肾结石的疗效比较

Comparative Study of First-Stage Combined Endoscopy and Single-Channel Percutaneous Nephroscopy in the Treatment of Complex Renal Calculi in Oblique Supine Lithotomy Position

目的比较分析斜仰卧截石位下I期双镜联合(单通道经皮肾镜联合逆行输尿管软镜)与单通道经皮肾镜治疗复杂性肾结石的有效性和安全性。方法收集2018年01月一2022年03月苏州大学附属常熟医院收治的50例复杂肾结石患者的临床资料,进行回顾性分析,其中研究组25例患者,斜仰卧截石位下同时采用单通道(18F)经皮肾镜和逆行输尿管软镜,进行双镜联合碎石治疗。对照组25例患者,斜卧位下采用单通道(18F)经皮肾镜碎石取石术治疗。比较两组患者结石清除率、血红蛋白下降量、手术时间、术后住院天数、治疗费用及并发症。结果研究组结石清除率、血红蛋白下降量明显优于对照组,差异具有统计学意义(P<0.05)。手术时间、术后住院天数、术后并发症研究组与对照组差异无统计学意义(P>0.05)。研究组治疗费用多于对照组,差异有统计学意义(P<0.05)。结论斜仰卧截石位下I期单通道经皮肾镜联合逆行输尿管软镜碎石能够有效地提高复杂肾结石的一次性结石清除率,明显降低手术的出血风险,是复杂肾结石的有效治疗方法。

Objective To compare and analyze the efficacy and safety of first-stage combined endoscopy(single-channel percutaneous nephroscopy combined with retrograde flexible ureteroscopy)with single-channel percutaneous nephroscopy in oblique supine lithotomy position in the treatment of complex renal stones.Methods Clinical data of 50 patients with complex renal stones admitted to Changshu Hospital of Soochow University from January 2018 to March 2022 were collected for retrospective analysis.Among them,25 patients in the study group were treated with single-channel(18F)percutaneous nephroscopy and retrograde flexible ureteroscopy in oblique supine lithotomy position.In the control group,25 patients were treated with single-channel(18F)percutaneous nephrolithotomy in oblique decubitus position.The stone clearance rate,hemoglobin decrease,operation time,postoperative hospital stay,treatment cost and complications were compared between the two groups.Results The stone clearance rate and the decrease of hemoglobin in the study group were significantly better than those in the control group,and the difference was statistically significant(P<0.05).There were no significant differences in operation time,postoperative hospital stay and postoperative complications between the study group and the control group.The treatment cost of the study group was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion First-stage single-channel percutaneous nephrolithotomy combined with retrograde flexible ureteroscopic lithotripsy in oblique supine lithotomy position can effectively improve the one-time stone clearance rate of complex renal calculi and significantly reduce the risk of surgical bleeding,which is an effective treatment for complex renal calculi.