摘要
目的探讨比较多通道经皮肾镜碎石术(PCNL)与单通道经皮肾镜联合输尿管软镜碎石术(ECIRS)治疗鹿角形肾结石的疗效。方法回顾性分析2015年1月至2019年12月中山大学孙逸仙纪念医院收治的多通道PCNL及单通道ECIRS治疗的鹿角形结石患者的临床资料。两组患者手术体位均为斜跨位(即斜仰卧-截石位),采用超声引导经皮肾穿刺;两组均常规留置F6双J管与肾造瘘管。术后24 h及术后1个月复查腹部平片(KUB)或计算机断层扫描(CT)评估结石清除率(SFR),无结石残留或残留碎片<4 mm视为结石清除。比较分析两组的SFR、手术时间、术中术后并发症、住院时间等。结果本研究共纳入135例患者,女70例,男65例,平均年龄50.8岁。其中74例行多通道PCNL,61例行单通道ECIRS。PCNL组肾结石长径为(58.5±11.4)mm,ECIRS组结石长径为(57.7±11.6)mm(P=0.658)。两组术后24 h的SFR(81.1% 比 80.3%)与术后1个月的SFR(91.9%比90.2%)差异均无统计学意义(均P>0.05)。PCNL组对比ECIRS组需更长的手术时间[M(Q1,Q3)为130(100,171)比105(90,135)min,P=0.015]。PCNL组的Clavien-Dindo 2级以上并发症的发生率更高(18.92%比1.64%,P<0.01),且住院时间长于ECIRS组[M(Q1,Q3)为8(7,9)比6(5,8)d,P<0.01]。结论斜跨位多通道PCNL和单通道ECIRS处理鹿角形肾结石均安全有效,两种手术方法的SFR相当,ECIRS组具有更低的术后并发症率、更短的手术时间及住院时间。
Objective To compare the outcomes of multi-tract percutaneous nephrolithotomy(PCNL)and simultaneous combined single-tract percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy(ECIRS)as treatment for staghorn stones.Methods The clinical data of patients with staghorn stones who were treated with multi-tract PCNL or single-tract ECIRS in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2015 to December 2019 were retrospectively analyzed.Two group of patients were placed in semisupine-lithotomy position(Galdakao-modified supine Valdivia position).We punctured into the renal calyces guided by ultrasonography.A F6 double J stent and a nephrostomy tube were routinely inserted in both groups.Kidney-ureter-bladder radiography(KUB)or computed tomography(CT)were done within 24 hours and 1 month after procedure to determine stone free rate(SFR).Stone free was defined as no residual stones or residual stones of<4 mm in diameter.The SFR,operating time,intraoperative and postoperative complications,and hospitalization time of the two groups were compared and analyzed.Results A total of 135 patients were included in the study,70 patients were female,65 patients were male.The average age were 50.8 years.A total of 74 patients were managed by multi-tract PCNL,while 61 patients were treated by single-tract ECIRS.The mean stone diameter was(58.5±11.4)mm in the PCNL group and(57.7±11.6)mm in the ECIRS group(P=0.658).Neither the 24-hour SFR(81.1%vs 80.3%)nor one-month SFR(91.9%vs 90.2%)after procedure was significantly different between the groups(both P>0.05).The operating time was significantly longer in PCNL group compared with ECIRS group[130(100,171)vs 105(90,135)min,P=0.015].The rate of Clavien-Dindo grade 2 or higher were significantly higher in the PCNL group than the ECIRS group(18.92%vs 1.64%,P<0.01).The PCNL group required longer hospitalization time than the ECIRS group[8(7,9)vs 6(5,8)d,P<0.01].Conclusions Both multi-tract PCNL and single-tract ECIRS treating staghorn stones in semisupine-lithotomy position are safe and effective.The two procedures have comparable SFR.However,the ECIRS group has lower rates of postoperative complications,shorter operating time and hospitalization time.
作者
黄裕棱
李卓航
刘成
韩金利
李奎庆
黄立
于浩
许可慰
Huang Yuleng;Li Zhuohang;Liu Cheng;Han Jinli;Li Kuiqing;Huang Li;Yu Hao;Xu Kewei(Department of Urology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第38期3121-3126,共6页
National Medical Journal of China
基金
国家自然科学基金(81572511)
广州市科技计划项目(201803010029)。
关键词
泌尿系疾病
鹿角形肾结石
斜跨位
多通道经皮肾镜碎石术
经皮肾镜联合输尿管软镜碎石术
Urologic diseases
Staghorn calculi
Semisupine-lithotomy position
Multi-tract percutaneous nephrolithotomy
Endoscopic combined intrarenal surgery
