肾蒂阻断下腹腔镜肾盂联合肾实质切开取石术治疗肾脏铸型感染性结石的临床研究
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摘要
目的:探索及评估肾蒂阻断下腹腔镜肾盂联合肾实质切开取石术治疗肾脏铸型感染性结石的有效性及安全性。方法:回顾性分析2014年3月~2015年3月17例接受肾蒂阻断下腹腔镜肾盂联合肾实质切开取石术患者的临床资料。本组患者中,男7性,女10例;年龄43~62岁,平均(57.3±13.4)岁。所有患者术前均通过超声、CT、IVP等影像学检查明确单侧肾脏内铸型结石,同时其双侧输尿管以下未见明显结石。其中肾内型肾盂12例,肾外型肾盂5例。患者肾脏铸型结石直径大小为1.5~4.0cm,平均(2.8±1.1)cm。所有患者术前检查均存在有明显泌尿系感染史,其中3例经影像学检查明确存在有肾盂脓性积液。术前患者均用抗生素预防性感染治疗3d。记录患者术前肾功能情况,并与术后3天肾功能进行比较。同时记录手术时间,术中肾蒂阻断时间,术中出血情况,术后住院天数,术后结石残留情况以及相关并发症,如感染、尿瘘等情况。结果:所有患者均成功完成手术,无一例行中转开放。手术时间为96~130min,平均(116±15)min,术中出血量均小于100ml,均未接受输血治疗。术中肾蒂阻断时间为25~35min,平均(30.6±5.7)min。术后住院时间为4~8d,平均(6.7±1.2)d.所有患者术后均未发生出血,感染,尿瘘等并发症。手术前后肾功能各项生化指标比较差异无统计学意义(P>0.05)。术后4周顺利拔除双J管,随访6~12个月,超声及IVP均提示无结石残留,肾盂输尿管无狭窄。结论:肾蒂阻断下后腹腔镜下肾盂联合肾实质切开取石术是治疗肾结石的一种安全、有效的微创治疗方式。尤其对于严重感染性结石患者,不适宜PCNL或输尿管软镜技术,有一定推广价值。
Objective:To evaluate the efficacy and safety of laparoscopic pyelolithotomy combined with nephrolithotomy under the renal pedicle blockage for treating the renal staghorn stone.Method:We retrospectively reviewed the clinical data of 17 patients with complex staghorn stone who accepted the retroperitoneal laparoscopic pyelolithotomy combined with nephrolithotomy under the renal pedicle blockage from March 2014 to March 2015.This study included seven males and ten females.Their mean age was(57.3±13.4)years old,and ranged from43 to 62years old.The unilateral staghorn stones were determined by ultrasound,CT,IVP preoperatively.Meanwhile,stones were not found in their bilateral ureters.The intrarenal pelvis was found in 12 cases and extrarenal pelvis was found in five cases.The diameter of stones ranged from 1.5to 4.0cm,mean(2.8±1.1)cm.A history of urinary infection was recorded in all patients before operation,including infected hydronephrosis in three cases.A 3-day antibiotic therapy was used in all of them.The preoperative renal function was measured,which was compared with that of three days after operation.Also,the operation time,the blockage duration of renal pedicle,estimated blood loss,hospital stay,the rate of free stone and the complications,such as infection and urine leakage were recorded.Result:All patients succeeded in the operation without the open surgery conversion.The mean operation time was(116±15)min,ranged from 96 to 130min.The estimated blood loss was less than100 ml in all patients.The duration of renal ischemia ranged from 25 to 35 min,mean(30.6±5.7)min.The mean hospital stay was(6.7±1.2)days,ranged from 4 to 8days.No bleeding,infection and urine leakage were found after the operation.There was no significant difference in the renal function between before and after operation.The double-J stents were removed by cystoscopy four weeks after the operation.Over 6-12 months follow-up period,the ultrasound and IVP examination suggested the free stone image.The bilateral renal pelvis and ureters were clear.No tendency of pyelo-ureter junctional stricture was found.Conclusion:The laparoscopic pyelolithotomy combined with nephrolithotomy under the renal pedicle blockage is an effective,safe and mini-invasive method for treating the complex staghorn renal stones especially in those patients with severe infected staghorn stones and those who were not suitable to undergo traditional PCNL or flexible ureteroscopic technique.It is worthy of popularizing.
Objective:To evaluate the efficacy and safety of laparoscopic pyelolithotomy combined with nephrolithotomy under the renal pedicle blockage for treating the renal staghorn stone.Method:We retrospectively reviewed the clinical data of 17 patients with complex staghorn stone who accepted the retroperitoneal laparoscopic pyelolithotomy combined with nephrolithotomy under the renal pedicle blockage from March 2014 to March 2015.This study included seven males and ten females.Their mean age was(57.3±13.4)years old,and ranged from43 to 62years old.The unilateral staghorn stones were determined by ultrasound,CT,IVP preoperatively.Meanwhile,stones were not found in their bilateral ureters.The intrarenal pelvis was found in 12 cases and extrarenal pelvis was found in five cases.The diameter of stones ranged from 1.5to 4.0cm,mean(2.8±1.1)cm.A history of urinary infection was recorded in all patients before operation,including infected hydronephrosis in three cases.A 3-day antibiotic therapy was used in all of them.The preoperative renal function was measured,which was compared with that of three days after operation.Also,the operation time,the blockage duration of renal pedicle,estimated blood loss,hospital stay,the rate of free stone and the complications,such as infection and urine leakage were recorded.Result:All patients succeeded in the operation without the open surgery conversion.The mean operation time was(116±15)min,ranged from 96 to 130min.The estimated blood loss was less than100 ml in all patients.The duration of renal ischemia ranged from 25 to 35 min,mean(30.6±5.7)min.The mean hospital stay was(6.7±1.2)days,ranged from 4 to 8days.No bleeding,infection and urine leakage were found after the operation.There was no significant difference in the renal function between before and after operation.The double-J stents were removed by cystoscopy four weeks after the operation.Over 6-12 months follow-up period,the ultrasound and IVP examination suggested the free stone image.The bilateral renal pelvis and ureters were clear.No tendency of pyelo-ureter junctional stricture was found.Conclusion:The laparoscopic pyelolithotomy combined with nephrolithotomy under the renal pedicle blockage is an effective,safe and mini-invasive method for treating the complex staghorn renal stones especially in those patients with severe infected staghorn stones and those who were not suitable to undergo traditional PCNL or flexible ureteroscopic technique.It is worthy of popularizing.
引文
1那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:129-179.
2 韩庆杰,吴万瑞,李元伟.肾结石微创技术治疗进展[J].国际泌尿系统杂志,2015,35(3):450-452.
3 Seitz C,Desai M,Hcker A,et al.Incidence,prevention,and management of complications following percutaneous nephrolitholapaxy[J].Eur Urol,2012,61(1):146-158.
4 李为兵.经皮肾镜碎石取石术并发症及其防治[J].中华泌尿外科杂志,2012,33(1):32-33.
5 Simforoosh N,Aminsharifi A.Laparoscopic management in stone disease[J].Curr Opin Urol,2013,23(2):169-174.
6 蒋建新,陈维开,王景群,等.肾盂联合肾实质切开治疗复杂性肾结石的疗效分析[J].实用临床医药杂志,2014,18(23):181-182.
7 钱庆鹏,于广海,杜浩.后腹腔镜肾实质切开取石术治疗肾结石[J].中国医药科学,2015,4:182-184.
8 周林玉,谈宜傲,曹正国,等.后腹腔镜肾蒂阻断肾实质切开治疗鹿角形结石[J].中国微创外科杂志,2010,10(4):319-320.
2 韩庆杰,吴万瑞,李元伟.肾结石微创技术治疗进展[J].国际泌尿系统杂志,2015,35(3):450-452.
3 Seitz C,Desai M,Hcker A,et al.Incidence,prevention,and management of complications following percutaneous nephrolitholapaxy[J].Eur Urol,2012,61(1):146-158.
4 李为兵.经皮肾镜碎石取石术并发症及其防治[J].中华泌尿外科杂志,2012,33(1):32-33.
5 Simforoosh N,Aminsharifi A.Laparoscopic management in stone disease[J].Curr Opin Urol,2013,23(2):169-174.
6 蒋建新,陈维开,王景群,等.肾盂联合肾实质切开治疗复杂性肾结石的疗效分析[J].实用临床医药杂志,2014,18(23):181-182.
7 钱庆鹏,于广海,杜浩.后腹腔镜肾实质切开取石术治疗肾结石[J].中国医药科学,2015,4:182-184.
8 周林玉,谈宜傲,曹正国,等.后腹腔镜肾蒂阻断肾实质切开治疗鹿角形结石[J].中国微创外科杂志,2010,10(4):319-320.