Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China.
Department of Urology, Taikang Xianlin Drum Tower Hospital, Nanjing University, Nanjing, 210000, China.
BMC Urol. 2022 Mar 19;22(1):38. doi: 10.1186/s12894-022-00994-w.
Endoscopic combined intrarenal surgery (ECIRS) is well established as a minimally invasive procedure for the treatment of multiple urolithiasis. The position is the key to the perfect combination of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Galdakao-modified supine Valdivia (GMSV) and prone split-leg positions are widely used. However, both positions have their own advantages and disadvantages. This study aimed to evaluate the effect of ECIRS in the treatment of multiple urolithiasis in the modified prone split-leg position.
A total of 96 patients with multiple urolithiasis underwent ECIRS in modified prone split-leg position from September 2017 to January 2021. Relevant demographic and clinical data were analysed retrospectively. Clinical outcomes, such as the stone free rate, complications and postoperative hospital stay were evaluated. The chi-square test was used to compare categorical variables and Student's t test was applied for continuous variables of the treatment groups.
The mean renal stone size was 32.5 ± 10.7 mm and renal stone surface area was 712.2 ± 264.8 mm. The mean ureteral stones size was 24.8 ± 12.3 mm. The mean surgical time was 82.2 ± 38.3 min. The incidence of complications was 16.7%, and they were mainly grade 1 and grade 2. No complications occurred above grade 3. The stone was completely removed in 75 (78.1%) patients in a single operation. The risk factors affecting the stone-free rate of ECIRS were analysed, and only the number of involved calyces by stone was found to be significant (p = 0.01).
ECIRS is safe and effective in the treatment of multiple renal calculi or multiple renal calculi with ipsilateral ureteral calculi in the modified prone split-leg position. The modification of the prone split-leg position makes the retrograde operation more convenient, which is conducive to the combination of RIRS and PCNL.
内镜下联合肾内手术（ECIRS）作为一种治疗多发性肾结石的微创方法已得到广泛认可。手术体位是经皮肾镜碎石术（PCNL）和逆行肾内手术（RIRS）完美结合的关键。改良的仰卧位加迪瓦利亚（GMSV）和俯卧位分腿位被广泛应用。然而，这两种体位都有各自的优缺点。本研究旨在评估改良俯卧分腿位在治疗多发性肾结石中的效果。
2017 年 9 月至 2021 年 1 月，96 例多发性肾结石患者在改良俯卧分腿位下行 ECIRS。回顾性分析相关的人口统计学和临床资料。评估临床疗效，如结石清除率、并发症和术后住院时间。采用卡方检验比较组间的分类变量，采用 Student's t 检验比较组间的连续变量。
肾结石平均大小为 32.5±10.7mm，肾结石表面积为 712.2±264.8mm。输尿管结石平均大小为 24.8±12.3mm。手术时间平均为 82.2±38.3min。并发症发生率为 16.7%，主要为 1 级和 2 级。无 3 级以上并发症发生。75 例（78.1%）患者在单次手术中完全清除结石。分析影响 ECIRS 结石清除率的危险因素，仅结石累及的肾盏数有显著影响（p=0.01）。
改良俯卧分腿位 ECIRS 治疗多发性肾结石或同侧肾结石合并输尿管结石是安全有效的。俯卧分腿位的改良使逆行操作更加方便，有利于 RIRS 和 PCNL 的结合。
