Kang N, Jiang Y H, Jiang Y G, Wu L Y, Zhang J Q, Niu Y N, Zhang J H
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Aug 18;52(4):692-696. doi: 10.19723/j.issn.1671-167X.2020.04.018.
To compare the outcomes of endoscopic combined ultrasound-guided access (EUGA) with the conventional ultrasound-guided access (UGA) to achieve percutaneous renal access in endoscopic combined intrarenal surgery (ECIRS).
A retrospective review of 53 patients undergoing ECIRS to treat upper urinary tract calculi between January 2017 and October 2019 was con-ducted. All of the cases were of complex upper urinary tract stones larger than 2 cm in diameter. The com-plex stone situations, such as multiple renal calyces calculi or staghorn calculi necessitated ECIRS. Under general anesthesia, the patients were placed in the galdakao-modified supine valdivia (GMSV) position, thus allowing both antegrade and retrograde accesss. The patients were divided to UGA and EUGA groups according to the protocol of achieving percutaneous renal access. In 28 cases, endoscopic combined ultrasound-guided accesss were obtained. Puncture and dilation were performed under direct flexible ureteroscopic visualization, while percutaneous renal access of 25 cases were performed with the conventional technique employing ultrasound guidance. Demographic and perioperative information, such as stone burden, presence of hydronephrosis and number of calyces involved was compared. Primary outcomes included total operative time, renal access time, repeat puncture, hemoglobin level, perioperative complications, and stone-free rate.
No major intra-operative complication was recorded in all the 53 ECRIS. No significant difference was observed between the groups in age and gender. There was no significant difference in body mass index[BMI (29.21±3.14) kg/m .(28.53±2.56) kg/m], stone burden (37.68±6.89) mm . (35.53±6.52) mm, number of calyces involved 2.72±0.68 . 2.86±0.71, presence of hydronephrosis (56.0% . 46.4%), total operative time (93.0±12.2) min . (96.8±14.2) min, hemoglobin level reduction (6.56±2.16) g/L . 97.54±2.64) g/L, stone-free rate (92.0% . 92.8%), hospital stay (5.52±0.59) d . (5.64±0.62) d, perioperative complication rate (8.0% . 7.2%). Two patients in EUGA group experienced perioperative complications (one urinary tract infection and one hematuria) while two patients in UGA group experienced perioperative urinary tract infection. None in both groups received blood transfusion. The patients undergoing EUGA had shorter renal access time [(4.0±0.7) min . (6.8±2.6) min, < 0.01] and less repeat puncture (0 . 4 cases, < 0.05).
EUGA is an optimal technique to establish percutaneous renal access in ECIRS, which minimizes access time and repeated procedures.
比较内镜联合超声引导穿刺（EUGA）与传统超声引导穿刺（UGA）在经皮肾镜联合腔内手术（ECIRS）中建立经皮肾穿刺通道的效果。
回顾性分析2017年1月至2019年10月期间53例行ECIRS治疗上尿路结石的患者。所有病例均为直径大于2 cm的复杂性上尿路结石。复杂的结石情况，如多个肾盏结石或鹿角形结石需要行ECIRS。在全身麻醉下，患者取改良仰卧瓦尔迪维亚（GMSV）体位，以便进行顺行和逆行穿刺。根据建立经皮肾穿刺通道的方案将患者分为UGA组和EUGA组。28例采用内镜联合超声引导穿刺。在可弯曲输尿管镜直视下进行穿刺和扩张，25例采用传统超声引导技术进行经皮肾穿刺。比较人口统计学和围手术期信息，如结石负荷、肾积水情况和受累肾盏数量。主要结局指标包括总手术时间、肾穿刺时间、重复穿刺次数、血红蛋白水平、围手术期并发症和结石清除率。
53例ECRIS患者均未发生术中严重并发症。两组患者在年龄和性别上无显著差异。体重指数[BMI（29.21±3.14）kg/m².（28.53±2.56）kg/m²]、结石负荷（37.68±6.89）mm².（35.53±6.52）mm²、受累肾盏数量2.72±0.68.2.86±0.71、肾积水情况（56.0%.46.4%）、总手术时间（93.0±12.2）min.（96.8±14.2）min、血红蛋白水平下降（6.56±2.16）g/L.（7.54±2.64）g/L、结石清除率（92.0%.92.8%）、住院时间（5.52±0.59）d.（5.64±0.62）d、围手术期并发症发生率（8.0%.7.2%）方面均无显著差异。EUGA组有2例患者发生围手术期并发症（1例尿路感染和1例血尿），UGA组有2例患者发生围手术期尿路感染。两组均无患者接受输血。接受EUGA的患者肾穿刺时间更短[（4.0±0.7）min.（6.8±2.6）min，P<0.01]，重复穿刺次数更少（0.4例，P<0.05）。
EUGA是ECIRS中建立经皮肾穿刺通道的最佳技术，可将穿刺时间和重复操作降至最低。
