Zhang J H, Jiang Y H, Jiang Y G, Zhang J Q, Kang N
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Aug 18;52(4):672-677. doi: 10.19723/j.issn.1671-167X.2020.04.014.
To discuss the efficacy and safety of simultaneous bilateral endoscopic surgery (SBES) for bilateral upper urinary tract calculi, and to summarize the initial experience.
Patients diagnosed with bilateral upper urinary tract calculi who underwent SBES in the Department of Urology, Beijing Chao-Yang Hospital from January 2019 to January 2020 were enrolled retrospectively. The demographic and clinical data of the patients were recorded, and the operation status, stone free rate (SFR) and peri-operative complications were analyzed. The primary end point was SFR, and second end point was peri-operative complications.
A total of 23 patients underwent SBES, of which SBES was completed in 19 patients (12 males, and 7 females). The mean age was (41.3±12.0) years. Fourteen patients underwent modified supine position surgery and 4 patients in prone split-leg position. There was no statistical difference in the demographic and baseline clinical data of the patients in different positions. One patient underwent right percutaneous nephrolithotomy (PCNL) and left endoscopic combined intra-renal surgery (ECIRS) in the prone split-leg position, while 18 patients received simul-taneous surgery with PCNL and contralateral retrograde intra-renal surgery (RIRS). The mean anesthesia and operation time was (128.7±26.5) min and (70.7±20.3) min, respectively, which was significantly longer in the patients with prone split-leg position than in the patients with modified supine position, anesthesia time in the patients with prone split-leg position and modified supine position: (148.4±20.4) min . (121.6±25.3) min, respectively, =－2.121, =0.049, while the operation time in the patients with prone split-leg position and modified supine position: (86.4±21.1) min . (65.1±17.4) min, respectively, =－2.222, =0.040. There was no significant difference between the two groups in indwelling of nephrostomy [prone split-leg position and modified supine position: (2.6±0.9) d . (2.1±1.0) d, respectively; =－0.880, =0.391] and the length of hospital stay [prone split-leg position and modified supine position: (6.0±2.7) d . (5.2±1.8) d, respectively; =－0.731, =0.475]. One month after the operation, the SFR was 78.9%, and 3 patients had minor peri-operative complications (Clavien-Dindo grades Ⅰ/Ⅱ) without any serious complications (Clavien-Dindo grades Ⅲ/Ⅳ/Ⅴ).
The simultaneous bilateral endoscopic surgery would decrease the operation time and anesthesia exposure under the premise of ensuring the SFR, which is helpful to reduce the risk of peri-operative complications, especially to the patients who can not tolerate the second-stage or long-time operation.
探讨同期双侧内镜手术（SBES）治疗双侧上尿路结石的疗效及安全性，并总结初步经验。
回顾性纳入2019年1月至2020年1月在北京朝阳医院泌尿外科接受SBES治疗的双侧上尿路结石患者。记录患者的人口统计学和临床资料，分析手术情况、结石清除率（SFR）及围手术期并发症。主要终点为SFR，次要终点为围手术期并发症。
共23例患者接受SBES，其中19例（男12例，女7例）完成手术。平均年龄为（41.3±12.0）岁。14例患者采用改良仰卧位手术，4例患者采用俯卧分腿位手术。不同体位患者的人口统计学和基线临床资料无统计学差异。1例患者在俯卧分腿位行右侧经皮肾镜取石术（PCNL）及左侧内镜联合肾内手术（ECIRS），18例患者同期行PCNL及对侧逆行肾内手术（RIRS）。平均麻醉时间和手术时间分别为（128.7±26.5）分钟和（70.7±20.3）分钟，俯卧分腿位患者的麻醉时间和手术时间均显著长于改良仰卧位患者，俯卧分腿位和改良仰卧位患者的麻醉时间分别为（148.4±20.4）分钟、（121.6±25.3）分钟，t=-2.121，P=0.049；俯卧分腿位和改良仰卧位患者的手术时间分别为（86.4±21.1）分钟、（65.1±17.4）分钟，t=-2.222，P=0.040。两组患者的肾造瘘管留置时间[俯卧分腿位和改良仰卧位分别为（2.6±0.9）天、（2.1±1.0）天；t=-0.880，P=0.391]及住院时间[俯卧分腿位和改良仰卧位分别为（6.0±2.7）天、（5.2±1.8）天；t=-0.731，P=0.475]无显著差异。术后1个月，SFR为78.9%，3例患者发生轻微围手术期并发症（Clavien-Dindo分级Ⅰ/Ⅱ），无严重并发症（Clavien-Dindo分级Ⅲ/Ⅳ/Ⅴ）。
同期双侧内镜手术在保证SFR前提下可缩短手术时间及减少麻醉暴露，有助于降低围手术期并发症风险，尤其适用于不能耐受二期手术或长时间手术的患者。
