机器人辅助腹腔镜与开放肾盂切开取石治疗直径大于2 cm非鹿角形肾结石的对比研究

 目的 探讨经腹达芬奇机器人辅助腹腔镜肾盂切开取石术(robot assisted laparoscopic pyelolithotomy,RALPL)治疗直径大于2 cm的非鹿角形肾结石的可行性和安全性。方法 针对我院2013年6月至2017年6月收治的直径大于2 cm的非鹿角形肾结石患者,回顾性分析其中采用RALPL (48例)与开放肾盂切开取石(open pyelolithotomy,OPL)(44例)手术方式的两组患者的临床资料,就初次结石清除率、平均手术时间、术后Hb降低值、术后下床时间、住院天数等指标进行对比研究。结果 相比OPL组,RALPL组初次结石清除率显著提高(91.66% vs.70.45%,P＜0.05),平均手术时间、术后Hb降低值、术后下床时间、住院天数均显著减少(P＜0.05)。RALPL组患者无Clavien Ⅱ级及以上并发症,OPL组Clavien Ⅱ级并发症2例。结论 经腹RALPL对肾盂、肾盏有良好的视角,能在肾盂低压状态且不损失肾实质的条件下确保较高的初次结石取净率,微创、有效、安全,是直径大于2 cm非鹿角形肾结石(包括合并肾盏结石)的可选适应证。

The comparison of robot-assisted laparoscopic and open pyelolithotomy in the management of nonstaghorn renal calculi larger than 2 cm

Objective To investigate the feasibility and safety of robot-assisted laparoscopic pyelolithotomy (RALPL) as the surgical management for nonstaghorn renal calculi larger than 2 cm. Methods Among the patients admitted to our hospital for nonstaghorn renal calculi larger than 2 cm between Jun.,2013 and Jun.,2017,a retrospective analysis was performed on the treatment outcome of patients undergoing RALPL (48 cases) and open pyelolithotomy (OPL) (44 cases).The initial stone-free rate,mean operating time,hemoglobin drop,off-bed activity time and hospital stay were compared between two groups.Results Compared with OPL group,RALPL group had a higher initial stone-free rate (91.66% vs.70.45%,P＜0.05),and had significant lesser hemoglobin drop,shorter operating time,off-bed activity time and hospital stay.There was no ClavienⅡor above complications in RALPL group,but there were 2 cases of ClavienⅡ complications in OPL group. Conclusions Transperitoneal approach RALPL has a better visual angle to observe renal pelvis and calyces,and can ensure a higher initial stone-free rate under the conditions of low intrarenal pelvic pressure and leaving renal parenchyma and vessels intact.RALPL is a minimally invasive,effective and safe treatment,and is an alternative indication for renal calculi larger than 2 cm (including renal pelvis stones with accompanying renal calyceal stones).