Analysis of percutaneous nephrolithotomy combined with ureteroscopic lithotripsy in first-stage treatment of complex nephrolithiasis in prone "split-leg" position

doi:10.3877/cma.j.issn.1674-3253.2021.04.006

Abstract

Abstract:

Objective

To investigate the feasibility and safety of percutaneous nephrolithotomy combined with ureteroscopic lithotripsy in first-stage operation in the prone "split-leg" position for complex renal calculi.

Methods

The 154 patients with complex renal calculi were admitted to our hospital from October 2017 to March 2020 with complicated renal calculi. All those patients were matched and divided into observation group and control group and were treated by percutaneous nephrolithotomy (PCNL) combined with flexible ureteroscopic lithotripsy. Patients in observation group were in the prone "split-leg" position but patients of control group were in oblique supine and lithotomy position. The operation time, intraoperative blood loss, postoperative hospital stay, nephrostomy tube extubation time, stone clearance rate, postoperative pain and 30-day postoperative complications were compared and analyzed between the two groups.

Results

The surgery was completed successfully in all the 154 cases. The operation time (122±37) minutes, nephrostomy tube extubation time (2.1±0.4) days, postoperative hospital stay (4.3±1.2) days, VAS score (1.9±0.2) and postoperative complications (6.5%) were significantly lower than that in the control group. There was no significant difference in intraoperative blood loss [22.2%(8/36) vs 58.3%(21/36), P<0.05] and stone clearance rate (93.5% vs 88%, P>0.05) between two groups.

Conclusion

Percutaneous nephrolithotomy combined with ureteroscopic lithotripsy in prone "split-leg" position is convenient, safe and effective with high stone clearance rate and quick recovery for complex renal calculi.

Key words: Percutaneous nephrolithotomy, Ureteroscopy, Complex kidney stones, First-stage, Position

Yangang Wang, Peixing Song, Defu Xing, Liangliang Li, Yameng Wu, Antao Dong, Zhenyu Huang, Yuanping Ye. Analysis of percutaneous nephrolithotomy combined with ureteroscopic lithotripsy in first-stage treatment of complex nephrolithiasis in prone "split-leg" position[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(04): 294-298.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2021.04.006

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2021/V15/I04/294

Figures/Tables 3

References 18

[1]	傅龙龙，王共先，傅斌. 泌尿系结石病因学的研究进展[J]. 国际泌尿系统杂志, 2015, 40(5): 968-970.
[2]	俞蔚文，张大宏，何翔,等. 联合不同口径多通道经皮肾镜取石术治疗复杂性肾结石[J]. 中国微创外科杂志, 2013, 13(9): 820-823.
[3]	李恒，姜书传. 标准通道、微通道经皮肾镜取石术治疗巨大肾结石的对比研究[J]. 腹腔镜外科杂志, 2014, 19(2): 105-108.
[4]	向宸辉，刘小勇，王鹏桥,等. 单通道PCNL联合输尿管软镜治疗老年复杂性肾结石疗效观察[J]. 西南国防医药, 2017, 27(7): 676-678.
[5]	刘小勇，邬韬，向宸辉,等. 经皮肾镜碎石术联合输尿管软镜碎石术治疗≥2 cm肾下盏结石的疗效观察[J]. 成都医学院学报, 2017, 12(6): 719-722.
[6]	王翊. 复杂性肾结石的手术治疗进展[J]. 医药前沿, 2017, 7(10): 9-10.
[7]	梁兆军，黎承杨，程继文, 等.经皮肾镜和逆行输尿管软镜处理≤2 cm肾结石的比较[J/CD].中华腔镜泌尿外科杂志(电子版), 2018, 12(6): 370-374.
[8]	冷松柏，钟毅，黄明. 输尿管软镜与微通道经皮肾镜治疗肾结石(≤2 cm)的比较[J/CD].中华腔镜泌尿外科杂志(电子版), 2017, 11(1): 33-36.
[9]	Lijun YI, Urology DO. The effect of flexible ureteroscopy and percutaneous renal lithotripsy (pcnl) in the treatment of renal calculi[J]. China Continuing Medical Education, 2016, 8(21): 114-116.
[10]	Huang X, Guo J, Zhang Y, et al. Eliminating residual renal calculi after PCNL by percutaneous nephrolithotomy with retrograde flexible ureteroscopy in second stage[J]. J Minimally Invasive Urology, 2016, 5(6): 343-346.
[11]	Wilhelm K, Hein S, Adams F, et al. Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of analgesic consumption and treatment-related patient satisfaction in patients with renal stones 10-35 mm[J]. World J Urol, 2015, 33(12): 2131-2136.
[12]	李金荣，邱学德，李泽惠, 等. PCNL中联合超声引导建立多通道并寻找残余结石治疗鹿角型肾结石的疗效观察[J]. 临床泌尿外科杂志, 2016, 31(4): 357-359.
[13]	付英华. 多通道经皮肾镜与单通道经皮肾镜联合输尿管软镜治疗复杂性肾结石的效果比较[J]. 黑龙江医学, 2017, 41(4): 321-322.
[14]	Chen W. Treatment for residual stone after PCNL with flexible ureteroscopy and holmium laser lithotripsy[J]. J Clini Urol, 2013, 28(3): 172-173, 176.
[15]	宋培星，谷涛. 同期分期单通道经皮肾镜联合输尿管软镜治疗复杂性肾结石的效果对比研究[J]. 山西医药杂志, 2018, 47(7): 788-791.
[16]	王凯，王广健. 单通道微创经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石的临床研究[J]. 中国医疗设备, 2016, 31(11): 110-112. URL
[17]	石映江，宫满成，任瑞, 等. 斜仰截石位微创经皮肾镜联合输尿管镜治疗肾及输尿管结石的临床探讨[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(1): 52-55.
[18]	苏帅，尹志康，王云龙, 等. 俯卧分腿位经皮肾镜碎石取石术治疗肾结石[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(6): 364-369.

组别	例数	性别(例)		年龄[岁，(±s)]	体质量指数[kg/m²，(±s)]	侧别(例)		结石最大横截面积[mm²，(±s)]	Guy’s分级(例)				S.T.O.N.E评分(±s)
组别	例数	男	女	年龄[岁，(±s)]	体质量指数[kg/m²，(±s)]	左	右	结石最大横截面积[mm²，(±s)]	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	S.T.O.N.E评分(±s)
观察组	77	44	33	40.5±3.9	24.3±3.9	35	42	817.8±124.5	8	16	33	20	7.7±2.8
对照组	77	40	37	41.1±5.5	23.8±4.5	38	39	832.2±146.4	10	16	30	21	7.9±2.6
统计值		χ²=0.419		t=0.430	t=0.463	χ²=0.234		t=0.729	χ²=0.169				t=0.512
P值		0.517		0.668	0.644	0.628		0.213	0.681				0.428

组别	例数	性别(例)		年龄[岁，(±s)]	体质量指数[kg/m²，(±s)]	侧别(例)		结石最大横截面积[mm²，(±s)]	Guy’s分级(例)				S.T.O.N.E评分(±s)
组别	例数	男	女	年龄[岁，(±s)]	体质量指数[kg/m²，(±s)]	左	右	结石最大横截面积[mm²，(±s)]	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	S.T.O.N.E评分(±s)
观察组	77	44	33	40.5±3.9	24.3±3.9	35	42	817.8±124.5	8	16	33	20	7.7±2.8
对照组	77	40	37	41.1±5.5	23.8±4.5	38	39	832.2±146.4	10	16	30	21	7.9±2.6
统计值		χ²=0.419		t=0.430	t=0.463	χ²=0.234		t=0.729	χ²=0.169				t=0.512
P值		0.517		0.668	0.644	0.628		0.213	0.681				0.428

组别	例数	手术时间(min)	术后血红蛋白下降量(g/L)	术后VAS评分(分)	拔造瘘管时间(d)	术后住院时间(d)
观察组	77	122±37	1.3±0.1	1.9±0.2	2.1±0.4	4.3±1.2
对照组	77	146±41	1.4±0.3	3.5±0.4	3.6±0.6	5.3±1.7
t值		2.288	1.718	19.236	11.066	2.550
P值		0.026	0.092	<0.001	<0.001	0.014

组别	例数	手术时间(min)	术后血红蛋白下降量(g/L)	术后VAS评分(分)	拔造瘘管时间(d)	术后住院时间(d)
观察组	77	122±37	1.3±0.1	1.9±0.2	2.1±0.4	4.3±1.2
对照组	77	146±41	1.4±0.3	3.5±0.4	3.6±0.6	5.3±1.7
t值		2.288	1.718	19.236	11.066	2.550
P值		0.026	0.092	<0.001	<0.001	0.014

Please choose a citation manager

Content to export