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
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摘要
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.
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.
引文
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[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]Ota?o 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 JUrol,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.
[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]Ota?o 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 JUrol,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.