切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 80 -84. doi: 10.3877/cma.j.issn.1674-3253.2019.02.003

所属专题: 文献

临床研究

腹腔镜辅助经皮肾镜与输尿管软镜治疗盆腔异位肾结石的临床研究
阮远1, 李杏1, 潘生玉1, 余伟民1, 饶婷1, 袁润1, 宁金卓1, 程帆1,()   
  1. 1. 430060 武汉大学人民医院泌尿外科
  • 收稿日期:2018-06-05 出版日期:2019-04-01
  • 通信作者: 程帆

Clinical study on percutaneous nephrolithotomy(PCNL) with laparoscopy assisted and retrograde intrarenal surgery(RIRS) for treatment of renal calculi in pelvic ectopic kidney

Yuan Ruan1, Xing Li1, Shengyu Pan1, Weimin Yu1, Ting Rao1, Run Yuan1, Jinzhuo Ning1, Fan Cheng1,()   

  1. 1. Department of Urology, Renmin's Hospital of Wuhan University, Wuhan 430060, China
  • Received:2018-06-05 Published:2019-04-01
  • Corresponding author: Fan Cheng
  • About author:
    Corresponding author: Cheng Fan, Email:
引用本文:

阮远, 李杏, 潘生玉, 余伟民, 饶婷, 袁润, 宁金卓, 程帆. 腹腔镜辅助经皮肾镜与输尿管软镜治疗盆腔异位肾结石的临床研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(02): 80-84.

Yuan Ruan, Xing Li, Shengyu Pan, Weimin Yu, Ting Rao, Run Yuan, Jinzhuo Ning, Fan Cheng. Clinical study on percutaneous nephrolithotomy(PCNL) with laparoscopy assisted and retrograde intrarenal surgery(RIRS) for treatment of renal calculi in pelvic ectopic kidney[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(02): 80-84.

目的

探讨经腹途径腹腔镜辅助经皮肾镜碎石取石术(PCNL)和输尿管软镜碎石术(RIRS)治疗盆腔异位肾结石的临床疗效。

方法

回顾性分析从2016年1月至2017年10月采用经腹途径腹腔镜辅助PCNL或RIRS手术方法治疗的6例盆腔异位肾结石病例。对患者术前的基本信息(包括年龄、性别、异位肾位置、结石大小、结石数量、结石位置、特殊病史)和术中、术后的基本情况(包括通道大小、手术时间、曲卡、肾造瘘管、腹腔引流管、双J管、结石清除率和住院时间)进行分析和总结。

结果

腹腔镜辅助PCNL和RIRS的平均手术时间分别为92 min和85 min,其平均结石最大径分别为19 mm和12 mm。RIRS术后的平均住院时间(3 d)短于腹腔镜辅助PCNL(5 d),其手术成功率分别为60%(3/5)和100%(3/3)。两种方法都没有严重并发症发生,术后复查均没有结石残留。

结论

两种手术方法治疗盆腔异位肾结石均具有较高的安全性。RIRS在微创和住院时间方面具有优势,腹腔镜辅助PCNL则能够应对更大的结石负荷和更复杂的肾脏结构,其手术成功率亦相对较高。

Objective

To explore the clinical efficacy of percutaneous nephrolithotomy(PCNL) with laparoscopy assisted and retrograde intrarenal surgery(RIRS) for treatment of renal calculi in pelvic ectopic kidney.

Methods

From January 2016 to October 2017, PCNL with laparoscopy assisted or RIRS were performed in 6 patients with calculi in pelvic ectopic kidney. Patient's demographics and perioperative characteristics (including age, sex, side of pelvic kidney, stone size, stone number, stone location, special medical history), operative and post-operative related details (including tract size, operation time, trocars, nephrostomy tube, abdominal drainage tube, double J stent, stone free, hospital stay) were reviewed.

Results

The mean operation time of PCNL with laparoscopy assisted and RIRS were 92 min and 85 min respectively, and the mean stone size were 19 mm and 12 mm respectively. In addition, the mean hospital stay time of RIRS was 3 days and less than that of PCNL with laparoscopy assisted (5 days), and the success rate were 60%(3/5) and 100%(3/3) respectively. None had serious complications and residual calculi.

Conclusions

Both PCNL with laparoscopy assisted and RIRS are safe options in the management of patients with renal calculi in pelvic ectopic kidney. RIRS has advantages in invasion and hospital stay, and PCNL with laparoscopy assisted has the ability to deal with bigger stones and more complex situations with a higher success rate.

表1 6例盆腔异位肾结石患者的基本信息
图1 盆腔异位肾结石患者的术前影像学检查
图2 盆腔异位肾结石患者术中操作及术后三维重建影像
表2 6例盆腔异位肾结石患者术中及术后相关情况
[1]
Zafar FS,Lingeman JE. Value of laparoscopy in the management of calculi complicating renal malformations[J]. J Endourol, 1996, 10(4): 379-383.
[2]
Tan YK,Cha DY,Gupta M. Management of stones in abnormal situations [J]. Urol Clin North Am, 2013, 40(1): 79-97.
[3]
Cinman NM,Okeke Z,Smith AD. Pelvic kidney: associated diseases and treatment [J]. J Endourol, 2007, 21(8): 836-842.
[4]
Otano N,Jairath A,Mishra S, et al. Percutaneous nephrolithotomy in pelvic kidneys: is the ultrasound-guided puncture safe?[J]. Urology, 2015, 85(1): 55-58.
[5]
Yin Z,Wei YB,Liang BL, et al. Initial experiences with laparoscopy and flexible ureteroscopy combination pyeloplasty in management of ectopic pelvic kidney with stone and ureter-pelvic junction obstruction [J]. Urolithiasis, 2015, 43(3): 255-260.
[6]
Talic RF. Extracorporeal shock-wave lithotripsy monotherapy in renal pelvic ectopia [J]. Urology, 1996, 48(6): 857-861.
[7]
Demirkesen O,Yaycioglu O,Onal B, et al. Extracorporeal shockwave lithotripsy for stones in abnormal urinary tracts: analysis of results and comparison with normal urinary tracts [J]. J Endourol, 2001, 15(7): 681-685.
[8]
Bush WH,Brannen GE. Extracorporeal shock-wave lithotripsy (ESWL) of pelvic kidney calculus. Use of C-arm fluoroscopy for correct patient positioning [J]. Urology, 1987, 29(4): 357-360.
[9]
Zhang W,Zhou T,Wu T, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy for treatment of lower pole renal stones: A meta-analysis and systematic review [J]. J Endourol, 2015, 29(7): 745-759.
[10]
Rao PN,Faulkner K,Sweeney JK, et al. Radiation dose to patient and staff during percutaneous nephrostolithotomy [J]. Br J Urol, 1987, 59(6): 508-512.
[11]
余伟民,曹君,阮远,等. 超声引导"经肾盏穹窿-盏颈轴线两步穿刺法"建立经皮肾通道 [J/CD]. 中华腔镜泌尿外科杂志(电子版),2016,10(3): 148-152.
[12]
Karamcheti A,O'Donnell WF. Percutaneous nephrolithotomy: an innovative extraction technique [J]. J Urol, 1977, 118(4): 671-672.
[13]
Agarwal M,Agrawal MS,Jaiswal A, et al. Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL) [J]. BJU Int, 2011, 108(8): 1346-1349.
[14]
Otaño N,Jairath A,Mishra S, et al. Percutaneous nephrolithotomy in pelvic kidneys: is the ultrasound-guided puncture safe?[J]. Urology, 2015, 85(1): 55-58.
[15]
Ganesamoni R,Sabnis RB,Mishra S, et al. Microperc for the management of renal calculi in pelvic ectopic kidneys[J]. Indian J Urol, 2013, 29(3): 257-259.
[16]
Bozkurt IH,Cirakoglu A,Ozer S. Retroperitoneal laparoscopic pyelolithotomy in an ectopic pelvic kidney[J]. JSLS, 2012, 16(2): 325-328.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[10] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[11] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[12] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要