Research of retrograde intrarenal surgery in treatment of upper urinary tract calculi in completely supine position
-
摘要: 目的 探讨完全平卧位下行逆行输尿管软镜碎石术(retrograde intrarenal surgery，RIRS)治疗上尿路结石的有效性及安全性。方法 回顾性分析2014年7月—2021年12月在江苏省中医院泌尿外科完成的41例完全平卧位下RIRS的上尿路结石患者的临床资料，作为观察组。同时选取24例同期采用截石位RIRS手术的患者作为对照组。比较2组住院时间、手术时间、结石清除率、术前及术后24 h内D-二聚体水平以及术后并发症发生率的差异。结果 2组患者在手术时间、住院时间、结石清除率、术后并发症方面差异均无统计学意义(P>0.05)。但观察组患者术后24 h内D-二聚体水平显著低于对照组，并且术后双下肢舒适度显著高于对照组，差异有统计学意义(P < 0.05)。结论 对于高龄、结石负荷大预计手术时间较长或者截石位摆放困难的患者，选择完全平卧体位完成RIRS是安全有效的。Abstract: Objective To investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) in treatment of upper urinary tract calculi in completely supine position.Methods Clinical data of 41 patients with upper urinary tract calculi who underwent RIRS in the completely supine position between July 2014 and December 2021 were retrospectively analyzed as the observation group. Other 24 patients who underwent RIRS in the lithotomy position during the same period were also selected as the control group. The hospitalization time, operation time, stone clearance rate, D-Dimer level and postoperative complication rate of the two groups were compared.Results There was no statistical difference between the two groups in terms of operative time, hospital stay, stone clearance rate or postoperative complications (P > 0.05). However, the postoperative D-Dimer level of patients in the observation group was significantly lower than that of the control group, and the postoperative comfort level of lower limbs was significantly higher in the observation group than that in the control group (P < 0.05).Conclusion It is safe and effective to directly choose the supine position to complete RIRS surgery for patients who are elderly, have a large stone size or have difficulty in placing lithotomy position.
-
Key words:
- completely supine position /
- flexible ureteroscopy /
- upper urinary calculi
-
-
表 1 2组患者术前术后D-二聚体水平比较
mg/L，X±S 组别 术前 术后 P值 观察组(41例) 0.31±0.06 0.34±0.03 0.336 对照组(24例) 0.28±0.05 0.92±0.11 < 0.001 P值 0.485 < 0.001 - 
下载: 导出CSV
表 2 2组患者术后并发症及舒适度比较
例(%)，X±S 组别 血尿 肾区疼痛 发热 输尿管石街 患者双下肢舒适度评分 观察组(41例) 5(12.20) 6(14.63) 4(9.76) 0 9.43±0.51 对照组(24例) 3(12.50) 3(12.50) 2(8.33) 1(4.17) 6.69±0.88 P值 1.000 0.561 0.611 0.369 0.001
下载: 导出CSV
-
[1] Turk C, Petrik A, Sarica K, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis[J]. Eur Urol, 2016, 69(3): 468-474. doi: 10.1016/j.eururo.2015.07.040
[2] 罗登科, 蔡扬柏, 容勋精, 等. 输尿管软镜治疗上尿路结石的研究进展[J]. 现代医药卫生, 2022, 38(3): 436-440. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS202203017.htm
[3] 黄翔, 苏珠英, 杨容, 等. 使用间歇性充气加压装置预防截石位手术患者下肢深静脉血栓的临床研究[J]. 中国医疗器械信息, 2017, 23(20): 1-2. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGQX201720001.htm
[4] Kallidonis P, Ntasiotis P, Somani B, et al. Systematic Review and Meta-Analysis Comparing Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery and Shock Wave Lithotripsy for Lower Pole Renal Stones Less Than 2 cm in Maximum Diameter[J]. J Urol, 2020, 204(3): 427-433. doi: 10.1097/JU.0000000000001013
[5] Croghan SM, Skolarikos A, Jack GS, et al. Upper urinary tract pressures in endourology: a systematic review of range, variables and implications[J]. BJU Int, 2023, 131(3): 267-279. doi: 10.1111/bju.15764
[6] 赵志健, 曾国华. 《2021 EULIS与IAU联合专家共识: 输尿管软镜碎石术》解读[J]. 临床泌尿外科杂志, 2022, 37(2): 83-85. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2022.02.001
[7] 张开能, 柯昌兴. 输尿管软镜联合负压吸引鞘治疗直径2~2.5 cm肾结石的疗效分析[J]. 东南国防医药, 2022, 24(02): 196-198. https://www.cnki.com.cn/Article/CJFDTOTAL-DNGY202202018.htm
[8] 鲁可权, 陈晨, 王臣, 等. 超微经皮肾镜与输尿管软镜治疗直径≤ 2 cm肾结石的效果分析[J]. 东南国防医药, 2018, 20(3): 254-257. https://www.cnki.com.cn/Article/CJFDTOTAL-DNGY201803008.htm
[9] 申广, 武立新, 李龙. 一期输尿管软镜治疗上尿路结石的疗效及影响因素分析[J]. 临床泌尿外科杂志, 2021, 36(10): 782-784. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW202110005.htm
[10] 杨嗣星, 陈志强. 软性输尿管镜术中国专家共识[J]. 中华泌尿外科杂志, 2016, 37(8): 561-565.
[11] Vladinov GM, Glick B, Aguirre HO, et al. Lower Extremity Injury While Undergoing Urology Procedures in the Trendelenburg with Lithotomy Position: Three Case Reports[J]. J Perianesth Nurs, 2021, 36(3): 214-218. http://www.sciencedirect.com/science/article/pii/S108994722030277X
[12] Saranteas T, Kostopanagiotou G, Tzoufi M, et al. Incidence of inferior vena cava thrombosis detected by transthoracic echocardiography in the immediate postoperative period after adult cardiac and general surgery[J]. Anaesth Intensive Care, 2013, 41(6): 782-787. http://europepmc.org/abstract/med/24180720
[13] Akhavan A, Gainsburg DM, Stock JA. Complications associated with patient positioning in urologic surgery[J]. Urology, 2010, 76(6): 1309-1316. http://www.sciencedirect.com/science/article/pii/S0090429510003390
-