斜仰截石位经皮肾镜联合软性输尿管镜治疗经皮肾镜取石术后残石的初步研究

Percutaneous nephrolithotomy (PCNL) combined with retrograde intrarenal surgery (RIRS) for residual stones after PCNL under a single position of lateral oblique lithotomy position

目的:探讨斜仰截石位经皮肾镜联合软性输尿管镜治疗经皮肾镜取石术后残石的临床价值。方法:2016年9月~2017年8月,采用斜仰截石位经皮肾镜联合软性输尿管镜治疗一期经皮肾镜取石术后残石(双镜联合组)16例,男7例,女9例,平均53.56(27~71)岁。均为复杂性肾结石行经皮肾镜取石术后结石残留,左侧7例,右侧9例。与同期行单纯PCNL治疗一期PCNL后残石患者(PCNL组)进行比较。PCNL组16例,男8例,女8例,平均56.63(23~76)岁。结果:双镜联合组和PCNL组所有手术均顺利完成。双镜联合组无石率93.8%(15/16)显著高于PCNL组31.3%(5/16)(P<0.05)。双镜联合组平均手术时间81.44(50~125)min,与PCNL组75.94(45~120)min、双镜联合组术后平均血红蛋白116.5(85~148)g/L与术前124.5(90~160)g/L、PCNL组术后平均血红蛋白107.4(76~128)g/L与术前117.7(79~151)g/L、双镜联合组平均住院时间13.5(12~15)d与PCNL组13(10~16)d相比差异均无统计学意义(P>0.05)。结论:斜仰截石位经皮肾镜联合软性输尿管镜治疗经皮肾镜取石术后残石,穿刺通道少,安全性和无石率高,值得临床推广应用。

Objective:To evaluate percutaneous nephrolithotomy(PCNL)combined with retrograde intrarenal surgery(RIRS)for residual stones after PCNL under a single position of lateral oblique lithotomy position.Methods:From September 2016 to August 2017,16 cases of residual stones after I-stage PCNL were treated by PCNL combined with RIRS under a single position of lateral oblique lithotomy position(combined double-endoscope group),including7 males and 9 females with the mean age of 53.56 years.All the cases were found with staghorn calculi before operation,including 7 cases in the left side and 9 cases in the right side.The comparison was done between combined double-endoscope group and PCNL group.There were 16 cases in the PCNL group,including 8 males and 8 females with the mean age of 56.63 years.Results:All the procedures in both combined double-endoscope group and PCNL group were completed successfully.The calculus clearance rate in combined double-endoscope group was 93.8%,which was higher than that(31.3%)of PCNL group(P<0.05).There was no significant difference between the postoperative and preoperative mean haematoglobin[116.5(85-148)g/L vs.124.5(90-160)g/L]in combined double-endoscope group(P>0.05).There was no significant difference between the postoperative and preoperative mean haematoglobin [107.4(76-128)g/L vs.117.7(79-151)g/L]in PCNL group(P>0.05).There was no significant difference in mean operative time and length of stay between combined double-endoscope group and PCNL group(P>0.05).Conclusions:PCNL combined with RIRS for residual stones after PCNL under a single position of lateral oblique lithotomy position is safe and efficient,with few puncture channels and high stone free rate.