Hamamoto Shuzo, Yasui Takahiro, Okada Atsushi, Takeuchi Mitsuru, Taguchi Kazumi, Shibamoto Yuta, Iwase Yutaka, Kawai Noriyasu, Tozawa Keiichi, Kohri Kenjiro
Department of Urology, Toyota Kosei Hospital, Toyota, Japan; Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Urology. 2014 Sep;84(3):565-70. doi: 10.1016/j.urology.2014.04.020. Epub 2014 Jun 12.
To develop a new technique for performing endoscopic combined intrarenal surgery in the prone split-leg position and to evaluate its efficacy using computed tomography.
Between December 2010 and January 2013, 60 patients with large calculi (39.2 ± 2.6 mm) underwent this surgery. A laser fiber was used with a flexible ureteroscope introduced through a ureteral access sheath, and lithoclast lithotripsy was performed through a mini-percutaneous tract. Three-dimensional computed tomography was performed to determine anatomic variations, including the ureteral location and ureteropelvic junction angle in all patients in both the supine and prone positions.
All procedures were performed successfully with a single tract and the patient in the prone split-leg position. The mean surgical time was 120.5 ± 6.7 min. The initial stone-free rate was 82%, and the final stone-free rate was 87% after further treatment. One patient required blood transfusion, but none had severe complications. Computed tomography showed that the ureter between the orifice and ureteropelvic junction was straighter and the ureteropelvic junction angle was significantly smaller for surgeries conducted in the prone position than the supine position.
Flexible ureteroscopy in the prone split-leg position is a viable technique. It allows easy insertion of the ureteral sheath and access of the ureteroscope to the renal pelvis. The findings suggest that this hybrid surgery is an efficient, effective, and versatile procedure for the management of renal calculi.
开发一种在俯卧分腿位进行内镜联合肾内手术的新技术，并使用计算机断层扫描评估其疗效。
2010年12月至2013年1月，60例患有大结石（39.2±2.6mm）的患者接受了该手术。使用激光光纤，通过输尿管鞘引入软性输尿管镜，并通过微通道经皮肾镜进行超声弹道碎石术。对所有患者在仰卧位和俯卧位均进行三维计算机断层扫描，以确定解剖变异，包括输尿管位置和肾盂输尿管连接部角度。
所有手术均在俯卧分腿位的患者中通过单通道成功完成。平均手术时间为120.5±6.7分钟。初始结石清除率为82%，进一步治疗后最终结石清除率为87%。1例患者需要输血，但无严重并发症发生。计算机断层扫描显示，与仰卧位手术相比，俯卧位手术时输尿管口与肾盂输尿管连接部之间的输尿管更直，肾盂输尿管连接部角度明显更小。
俯卧分腿位软性输尿管镜检查是一种可行的技术。它便于输尿管鞘的插入以及输尿管镜进入肾盂。研究结果表明，这种联合手术是一种治疗肾结石的高效、有效且通用的方法。
