Hamamoto Shuzo, Yasui Takahiro, Okada Atsushi, Koiwa Satoshi, Taguchi Kazumi, Itoh Yasunori, Kawai Noriyasu, Hashimoto Yoshihiro, Tozawa Keiichi, Kohri Kenjiro
1 Department of Urology, Toyota Kosei Hospital , Toyota, Japan .
J Endourol. 2015 Jan;29(1):19-24. doi: 10.1089/end.2014.0372.
Abstract Purpose: To evaluate the efficacy of endoscopic combined intrarenal surgery (ECIRS) using retrograde flexible ureteroscopy and miniature percutaneous nephrolithotomy (PNL) for the treatment of patients with staghorn calculi in the prone split-leg position.
We retrospectively reviewed the records of 42 patients with staghorn calculi (45.8±3.2 mm) who underwent ECIRS using retrograde flexible ureteroscopy and miniature PNL in the prone split-leg position for the treatment of staghorn calculi in our center between December 2010 and August 2013. A flexible ureteroscope with a laser fiber was inserted through a ureteral access sheath, and lithoclast lithotripsy was performed through a mini-percutaneous tract. Both procedures were performed simultaneously by two urologists. Surgical parameters, including surgical time, stone-free (SF) rates, modified Clavien complication grades, and risk factors for residual stones, were analyzed.
Fifteen patients (35.7%) had complete staghorn calculi. Among the 42 staghorn calculi treated, 23 had 0 to 5 stone branches, 14 had 6 to 10 stone branches, and 5 had ≥11 stone branches. All procedures were performed successfully using a single lithotripsy tract with the patient in the prone split-leg position. The mean surgical time was 143.2±9.2 minutes. The initial SF rate was 71.4%, and the final SF rate was 83.3% after further treatment. One patient required a blood transfusion (2.4%), but no patient experienced a ≥3 Clavien grade complication. Risk factors for residual stones were stone size, stone surface area, complete staghorn calculi, and the number of stone branches.
ECIRS for staghorn calculi in the prone split-leg position is a safe, efficient, and versatile method for the effective management of staghorn calculi without the creation of multiple percutaneous tracts.
摘要 目的：评估采用逆行软性输尿管镜和微通道经皮肾镜取石术（PNL）的内镜联合肾内手术（ECIRS）在俯卧分腿位治疗鹿角形结石患者的疗效。
我们回顾性分析了2010年12月至2013年8月期间在本中心采用逆行软性输尿管镜和微通道PNL在俯卧分腿位对42例鹿角形结石（45.8±3.2毫米）患者进行ECIRS治疗的记录。将带有激光光纤的软性输尿管镜通过输尿管鞘插入，经微通道经皮肾穿刺通道进行超声碎石清石术。这两个操作由两名泌尿外科医生同时进行。分析手术参数，包括手术时间、结石清除率（SF）、改良Clavien并发症分级以及残留结石的危险因素。
15例（35.7%）患者为完全鹿角形结石。在治疗的42例鹿角形结石中，23例有0至5个结石分支，14例有6至10个结石分支，5例有≥11个结石分支。所有操作均在患者俯卧分腿位通过单一碎石通道成功完成。平均手术时间为143.2±9.2分钟。初始结石清除率为71.4%，进一步治疗后最终结石清除率为83.3%。1例患者需要输血（2.4%），但无患者发生≥3级Clavien并发症。残留结石的危险因素为结石大小、结石表面积、完全鹿角形结石和结石分支数量。
在俯卧分腿位对鹿角形结石进行ECIRS是一种安全、有效且通用的方法，可有效处理鹿角形结石，无需建立多个经皮通道。
