斜仰卧截石位经皮肾镜联合逆行输尿管软镜治疗 复杂性鹿角形肾结石的疗效分析

Analysis of effect of percutaneous nephrolithotomy combined with retrograde flexible ureteroscopy on semi-supine and lithotomy position in treatment of complex staghorn renal calculi

摘要:

目的 探讨斜仰卧截石位经皮肾镜一期联合逆行输尿管软镜治疗复杂性鹿角形结石的有效性和 安全性。方法 选取2016 年9 月—2018 年7 月邢台市人民医院收治的83 例复杂性鹿角形结石患者，随机分 为观察组41 例和对照组42 例。观察组：男性23 例，女性18 例；年龄43 ～ 67 岁，平均52.5 岁；结石最大 径3.4 ～ 6.0 cm，平均4.4 cm；左肾结石20 例，右肾结石21 例；STONE 评分8 ～ 12 分，平均10.1 分。对照组： 男性21 例，女性21 例；年龄39 ～ 63 岁，平均51.1 岁；结石最大径3.2 ～ 5.7 cm，平均4.3 cm；左肾结石24 例， 右肾结石18 例；STONE 评分8 ～ 12 分，平均9.7 分。观察组行斜仰卧截石位标准通道经皮肾镜一期联合逆 行输尿管软镜碎石取石术，对照组行常规俯卧位标准通道经皮肾镜碎石取石术。观察两组结石清除率、术中 出血、尿路感染和炎症相关因子及手术时间等指标。结果 两组一般资料比较，差异无统计学意义（P >0.05）。 观察组与对照组术后2 周结石清除率、术后血红蛋白下降程度、术后输血率、尿路感染发生率、术后首日平 均降钙素原水平分别为 85.3% VS 52.4%、（18±7.8）g/L VS（ 24±11.9）g/L、4.9% VS 19.0%、22.0% VS 42.9% 及（0.55±0.23）ng/ml VS（ 1.17±0.46）ng/ml，两组比较差异有统计学意义（P <0.05）。观察组与对照组平 均手术时间分别为（121.0±16.8）和（113.0±13.2）min，两组比较差异无统计学意义（P >0.05）。结论 斜 仰卧截石位双镜联合治疗复杂性鹿角形肾结石清除率高、并发症少，是一种安全有效的治疗方法。

Abstract:

Objective To discuss the effect and safety of percutaneous nephrolithotomycombined with retrograde flexible ureteroscopy on semi-supine and lithotomy position in the treatment of complex staghorn renal calculi. Methods We selected 83 patients with complex staghorn renal calculi admitted into our hospital from Sep. 2016 to July 2018, and then randomly divided them into observation group and control group. Observation group: 23 cases of male and 18 cases of female, aged from 43 to 67 and the average age was 52.5; the biggest diameter of calculus was from 3.4 to 6.0cm, and the average diameter was 4.4cm; there were 20 cases of left renal calculus and 21 cases of right renal calculus; STONE assessment was from 8 to 12 scores, and average score was 10.1 scores. Control group: 21 cases of male and 21 cases of female, aged from 39 to 63 and average age was 51.1; the biggest diameter of calculus was from 3.2 to 5.7cm, and the average diameter was 4.3cm; there were 24 cases of left renal calculi and 18 cases of right renal calculi; STONE assessment was from 8 to 12 scores, and the average score was 9.7 scores. There was no significant difference between the two groups (P > 0.05). The patients of observation group were given percutaneous nephrolithotomy combined with retrograde flexible ureteroscopy by semi-supine and lithotomy position and the patients of control group were given percutaneous nephrolithotomy by standard way and on routine position to take lithoclasty and lithotomy. We observed the clearance of calculi, amount of bleeding during the operation, related factors of inflammatory and urinary tract infection and other indexes of the two groups. Results There was no significant difference in general data between the two groups (P > 0.05). Indexes two hours after the surgery of observation group and control group included clearance of calculi: 85.3% (35/41) VS 52.4% (22/42), postoperative hemoglobin rate of descent: (18±7.8) g/L VS (24±11.9) g/L, postoperative blood transfusion rate: 4.9% (2/41) VS 19.0% (8/42), incidence rate of urinary tract infection: 22.0% (9/41) VS 42.9% (18/42) and average procalcitonin on the first day after operation: (0.55±0.23) ng/ml VS (1.17±0.46) ng/ml; there was statistical significance between the two groups (all P < 0.05). The average operative time of the two groups were (121±16.8) min and (113±13.2) min, respectively, and the difference was not statistically significant (P = 0.5573). Conclusions Percutaneous nephrolithotomy combined with retrograde flexible ureteroscopy by semi-supine and lithotomy position in the treatment of complex staghorn renal calculi has high clearance of renal calculi, less complication and it is a safe and effective therapy.