一期完全俯卧位双镜联合治疗复杂性肾结石的应用研究

Application of percutaneous nephrolithotomy combined with retrograde intrarenal surgery in prone positioning in treatment of complex kidney stones

摘要:

目的 探讨一期完全俯卧位双镜联合治疗复杂性肾结石的安全性及临床疗效。方法 回顾性分析2014年1月－2018年8月该院泌尿外科67例复杂性肾结石患者的临床资料。其中，31例采用一期完全俯卧位双镜联合碎石术（双镜组），36例采用俯卧位单通道经皮肾镜碎石术（PCNL）（肾镜组）。对比两组手术时间、术中出血量、围术期并发症Clavien-Dindo分级、清石率以及住院时间。结果 67例患者均顺利完成手术，无Clavien-Dindo评级为Ⅲ_B级以上围术期严重并发症发生。双镜组手术时间较肾镜组长（P = 0.000），住院时间较肾镜组短（P = 0.000）；两组患者治疗前S.T.O.N.E.评分以及结石面积比较，差异均无统计学意义（P > 0.05），治疗后双镜组术中出血量、围术期并发症Clavien-Dindo分级、清石率均明显优于肾镜组（P < 0.05）。结论 一期完全俯卧位双镜联合治疗复杂性肾结石安全，疗效显著，具有一期清石率高和并发症少的特点，值得临床推广应用。

Abstract:

Objective To investigate the safety and efficacy of percutaneous nephrolithotomy combined with retrograde intrarenal surgery in prone positioning in treatment of complex kidney stones.Methods Clinical data of 67 patients with complex kidney stones from January 2014 to August 2018 were retrospectively analyzed. 31 patients underwent percutaneous nephrolithotomy combined with retrograde intrarenal surgery in prone positioning (Double endoscopy group), 36 patients underwent minimally invasive percutaneous nephrolithotomy (PCNL group), operation time, bleeding volume, the Clavien-Dindo classification, stone clearance rate and the median length of hospital stay were compared and analyzed.Results All the 67 patients underwent operation successfully without serious complications. The operation time of the Double endoscopy group is longer than that of the PCNL group (P = 0.000), and the median length of hospital stay is shorter (P = 0.000). There is no significant difference in the quantitative indicator of surgical difficulty (S.T.O.N.E.) and kidney stone size between the two groups (P > 0.05). The bleeding volume, the Clavien-Dindo classification and stone clearance rate of the Double endoscopy group is better than PCNL group (P < 0.05).Conclusion Percutaneous nephrolithotomy combined with retrograde intrarenal surgery in prone positioning in treatment of complex kidney stones is safe, effective and reliable. As this results shows, it has characteristics such as high stone clearance rate with a low complication rate, and is worthy of clinical application.