蒋廷森　吴锦昌

[摘要] 目的 探讨俯卧位经腰背部入路后腹腔镜配合输尿管硬镜治疗肾结石的效果及优势。 方法 选取2011年12月～2013年12月入住本院治疗肾结石的患者102例，将其随机分成治疗组及对照1、2组，每组各34例。治疗组采用俯卧位经腰背部入路后腹腔镜配合输尿管硬镜法取石，对照1组采用经皮肾镜取石术取石，对照2组采用常规侧卧位后腹腔镜肾盂切开法取石，比较3组的术中出血量、手术时间、住院时间、并发症及结石取尽率情况。 结果 治疗组的术中出血量、手术时间、住院时间、并发症发生率、结石取尽率分别为（83.4±16.2）ml、（101.3±9.7）min、（6.5±1.4）d、2.94%、100%，治疗组的术中出血量少于对照1、2组，手术、住院时间均短于对照1、2组，并发症发生率低于对照1、2组，结石取尽率高于对照1、2组（P<0.05）。 结论 后腹腔镜配合输尿管硬镜治疗肾结石具有术中出血量少，手术、住院用时短，并发症少以及取石彻底等优势，值得临床推广应用。

[关键词] 肾结石；后腹腔镜；输尿管硬镜

[中图分类号] R692.4 [文献标识码] B [文章编号] 1674-4721（2014）04（b）-0189-03

[Abstract] Objective To explore the effect and advantage of prone position retroperitoneoscopy by the approach of lumbar spinal cord combined with rigid ureteroscopy in the treatment of kidney stone. Methods 102 patients with kidney stone who were hospitalized and treated in our hospital from December 2011 to December 2013 were selected and randomly divided into the treatment group （n=34），the control group 1 （n=34） and the control group 2 （n=34）.The treatment group received prone position retroperitoneoscopy by the approach of lumbar spinal cord combined with rigid ureteroscopy to remove the stones，the control group 1 received percutaneous nephrolithotripsy to remove the stones，the control group 2 received conventional lateral position retroperitoneoscopic pelvis incision to remove the stones，the intraoperative blood loss，surgical time，hospital stay，complications and depletion rate of stones of the three groups were compared. Results The intraoperative blood loss，surgical time，hospital stay，complications and depletion rate of stones of the treatment group was （83.4±16.2）ml，（101.3±9.7）min，（6.5±1.4）d，2.94%，100% respectively，intraoperative blood loss in the treatment group was fewer than that in the control group 1 and 2，surgical time，hospital stay of the treatment group was shorter than those in the control group 1 and 2，the incidence rate of complication in the treatment group was lower than that in the control group 1 and 2，depletion rate of stones in the treatment group was higher than that in the control group 1 and 2 （P<0.05）. Conclusion Retroperitoneoscopy combined with rigid ureteroscopy in the treatment of kidney stone has the advantages of less intraoperative blood loss，shorter surgical time and hospital stay，fewer complications and thorough stone removal.It is worthy of clinical promotion and application.

[Key words] Kidney stones；Retroperitoneoscopy；Rigid ureteroscope

对于需外科手术干预的肾结石的治疗，国内大多数医院采用经皮肾镜取石术或后腹腔镜下肾盂切开取石术法[1]。经皮肾镜碎石取石术由于有出血、集合系统损伤、术中灌注压高致感染乃至脓毒血症等并发症而限制了它的推广，而后腹腔镜下肾盂切开取石术，常规取健侧卧位建立和扩张后腹腔作为入路，术中由于体位因素，输尿管硬镜不易通过肾盂切口进入肾盏，清除肾盏以及铸型结石[2]。本院和坦背医院采用俯卧位经腰背部入路，通过腹腔镜与输尿管硬镜相结合的方法取石，此法能够让输尿管硬镜经皮经肾盂切口更易到达肾盂清除结石，术中联合气压弹道或者钬激光碎石，不但适用于肾盂多发性结石、肾铸形结石，同样适用于肾结石合并肾积脓。……