Clinical study of simultaneous bilateral endoscopic surgery for bilateral upper urinary tract calculi
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摘要: 目的 探讨俯卧分腿位下双侧同时内镜手术治疗双侧上尿路结石的安全性和有效性。方法 回顾性分析安徽医科大学第二附属医院2019年5月—2021年3月在俯卧分腿位下双侧同时内镜手术治疗的20例双侧上尿路结石患者的临床资料，所有患者均为一侧行经皮肾镜取石术，另一侧行输尿管软镜碎石术，手术由两组医生同时完成，记录患者血红蛋白、肾功能的变化，结石清除率及并发症发生情况。结果 20例患者均顺利完成手术，平均手术时间为(83.8±21.4)min，术后平均住院天数(6.8±1.8)d，术后一期结石清除率为85%(17/20)。术后第1天平均血红蛋白为(112.4±22.9)g/L，低于术前平均血红蛋白[(123.8±22.7)g/L](P＜0.05)；术后第1天平均血肌酐为(126.1±49.3)μmol/L，高于术前平均血肌酐[(102.9±45.9)μmol/L](P＜0.05)；术后第1天平均胱抑素C为(1.1±0.6)mg/L，低于术前平均胱抑素C[(1.3±0.7)mg/L](P＜0.05)。所有患者术后3~5 d肌酐基本降至正常或术前水平。术后4例发生并发症，Clavien-Dindo分级：Ⅰ级3例，Ⅱ级1例，未发生严重并发症。结论 俯卧分腿位下双侧内镜同时治疗双侧上尿路结石安全、可行，在有效的手术时间内提高双侧结石清除率，减少麻醉暴露时间和手术次数。Abstract: Objective To investigate the feasibility and safety of simultaneous bilateral endoscopic surgery in the prone split-leg position for bilateral upper urinary tract calculi.Methods The clinical data of 20 patients with bilateral upper urinary tract calculi treated by simultaneous bilateral endoscopic surgery in prone split-leg position admitted to the Second Affiliated Hospital of Anhui Medical University from May 2019 to March 2021were retrospectively analyzed. All patients underwent percutaneous nephrolithotomy on one side and flexible ureteroscopic lithotripsy on the other. The operation was performed by two urologists at the same time. The operation parameters, stone clearance rate and complications were recorded and analyzed.Results All the 20 patients were completed the operation successfully. The mean operation time was (83.8 ± 21.4) min and the average postoperative hospital stay was (6.8 ± 1.8) days. The stone free rate was 85% (17 / 20) in the first stage after operation. First day after operation vs. before operation: mean hemoglobin (112.4 ± 22.9 vs. 123.8 ± 22.7)g/L, mean serum creatinine (126.1 ± 49.3 vs. 102.9 ± 45.9)μmol/L, Cystatin C (1.1 ± 0.6 vs. 1.3 ± 0.7)mg/L, allP< 0.05. Creatinine of all patients decreased to normal or preoperative level 3-5 days after operation. Postoperative complications occurred in 4 cases, 3 cases of Clavien-Dindo grade Ⅰ and 1 case of grade Ⅱ, but no serious complications occurred.Conclusion It is safe and feasible to treat bilateral upper urinary tract calculi by simultaneous bilateral endoscopic surgery in prone split-leg position. It can improve the stone free rate of bilateral renal calculi within effective operation time and reduce the anesthesia exposure time and operation times.
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