3D腹腔镜肾盂成形联合超声引导下输尿管软镜碎石取石术治疗肾盂输尿管连接部梗阻合并肾结石的有效性及安全性

Efficacy and safety of 3-dimensional laparoscopic pyeloplasty and ultrasound-guided flexible ureteroscopy lithotripsy in the treatment of ureteropelvic junction obstruction and renal calculi

目的分析3D腹腔镜肾盂成形联合超声引导下输尿管软镜碎石取石术(3DLP-UGFURL)治疗肾盂输尿管连接部梗阻(UPJO)合并肾结石的有效性与安全性。方法回顾性分析首都医科大学附属北京朝阳医院泌尿外科2017年12月-2022年7月行3DLP-UGFURL治疗的29例UPJO合并肾结石患者的临床资料。其中男性23例、女性6例。平均年龄(35.3±13.6)岁。左侧20例,右侧9例,均为单侧发病,其中合并马蹄肾1例。平均体质量指数23.6±3.9。肾盂或肾盏多发结石16例,其余均为单发结石。结石最大径平均(1.2±0.6)cm。轻度肾积水2例,中度肾积水19例,重度肾积水8例。结果29例手术均获得成功,其中3DLP手术时间平均为(84.2±15.4)min;UGFURL手术时间平均为(42.8±15.7)min;出血量平均为(36.9±13.6)mL。引流管留置时间平均为(3.6±1.6)d。尿管留置时间和术后平均住院时间为(6.8±1.2)d;术后1个月清石率平均为97.4%;输尿管支架管留置时间平均为2.7个月。随访时间平均为(24.5±10.0)个月。共出现45例次并发症,均为Clavien-Dindo 1级。结论3DLP-UGFURL可以安全有效地治疗UPJO合并肾结石,但仍需长期随访的临床资料对该术式进一步评估。

Objective To evaluate the efficacy and safety of 3-dimensional laparoscopic pyeloplasty and ultrasound-guided flexible ureteroscopy lithotripsy(3DLP-UGFURL)in the treatment of ureteropelvic junction obstruction(UPJO)and renal calculi.Methods The clinical data of 29 patients of UPJO complicated with renal calculi treated with 3DLP-UGFURL during Dec.2017 and Jul.2022 were retrospectively analyzed.There were 23 males and 6 females with average age of(35.3±13.6)years.The lesions were on the left side in 20 cases,on the right side in 9 cases,and all were unilateral.One case was complicated with horseshoe kidney.The body mass index(BMI)was 23.6±3.9.Multiple calculi of renal pelvis or calyces occurred in 16 cases,and the rest were single calculi.The maximum diameter of calculi was(1.2±0.6)cm.There were 2 cases of mild hydronephrosis,19 cases of moderate hydronephrosis and 8 cases of severe hydronephrosis.Results All operations were successful.The operation time of 3DLP was(84.2±15.4)min.Operation time of UGFURL was(42.8±15.7)min.Estimated blood loss was(36.9±13.6)mL.Indwelling time of drainage tube was(3.6±1.6)d.Indwelling time of urinary catheter and postoperative hospital stay was(6.8±1.2)d.One month after operation,the stone removal rate was 97.4%.The retention time of ureteral stent was 2.7 months.During the follow-up of(24.5±10.0)months,there were 45 Clavien Dindo grade 1 complications.Conclusion 3DLP-UGFURL is safe and effective in the treatment of UPJO complicated with renal calculi,but it still needs long-term follow-up data.