侧卧位输尿管软镜碎石术治疗肾下盏结石的安全有效性分析：一项随机对照试验

doi:10.3760/cma.j.cn441417-20241226-13003

摘要/Abstract

摘要：

目的　对比分析侧卧位与截石位下输尿管软镜碎石术（RIRS）治疗肾下盏结石的安全性及有效性。方法　本研究为随机对照试验。2023年1月至2024年11月佛山市三水区乐平镇人民医院收治的80例肾下盏结石患者纳入本研究并按随机数字表法分为两组，分别在传统截石位和侧卧位下行RIRS。侧卧位组男女比21∶19，年龄（44.1±10.3）岁，结石大小（1.49±0.35）cm；截石位组男女比22∶18，年龄（45.2±12.7）岁，结石大小（1.56±0.42）cm。比较两组体位摆放时间、手术时间、手术结果和并发症。采用独立样本t检验、χ²检验、Fisher确切概率法进行统计学分析。结果　侧卧位组和截石位组体位摆放时间分别是（7.1±2.4）min和（4.0±1.2）min（P<0.001），但是侧卧位组手术时间短于截石位组［（51.5±9.9）min比（65.2±7.3）min，P<0.001］。侧卧位组灌注液使用量大于截石位组［（5 356.4±223.8）ml比（3 272.5±457.2）ml，P<0.001］。两组术后发热率差异无统计学意义［5.0%（2/40）比7.5%（3/40），P=0.644］，两组术后血红蛋白下降量、住院时间差异也无统计学意义［（7.8±2.8）g/L比（9.2±3.2）g/L、（0.78±0.29）d比（0.82±0.31）d，P=0.823、0.947］。术后1个月复查CT，侧卧位组结石清除率（stone free rate，SFR）高于截石位组［95.0%（38/40）比80.0%（32/40），P=0.043］。结论　侧卧位结合灌注冲刷以及负压吸引鞘的主动吸引清除效应，提高了RIRS治疗肾下盏结石的碎石效率，缩短了手术时间，提高了术后SFR。

关键词:

输尿管软镜碎石术, 侧卧位, 截石位, 肾下盏结石, 结石清除率, 并发症

Abstract:

Objective　To compare and analyze the safety and efficacies of retrograde intrarenal surgery (RIRS) in the lateral position and the lithotomy position in the treatment of renal lower pole stones. Methods　This study was a randomized controlled trial. A total of 80 patients with renal lower pole stones admitted to People's Hospital of Leping Town, Sanshui District from January 2023 to November 2024 were included in this study and were divided into two groups according to the random number table method, who underwent RIRS in the traditional lithotomy position and the lateral position, respectively. In the lateral position group, the ratio of male to female was 21:19, with an age of (44.1±10.3) years old and a stone size of (1.49±0.35) cm. In the lithotomy position group, the ratio of male to female was 22:18, with an age of (45.2±12.7) years old and a stone size of (1.56±0.42) cm. The time for placing the position, operation time, surgical outcomes, and complications were compared between the two groups. Statistical analysis was conducted using independent sample t-test, χ² test, and Fisher's exact probability method. Results　The time for placing the position in the lateral position group and the lithotomy position group were (7.1±2.4) min and (4.0±1.2) min, respectively (P<0.001), but the operation time in the lateral position group was shorter than that in the lithotomy position group [(51.5±9.9) min vs. (65.2±7.3) min, P<0.001]. The volume of perfusion fluid used in the lateral position group was more than that in the lithotomy position group [(5 356.4±223.8) ml vs. (3 272.5±457.2) ml, P<0.001]. There was no statistically significant difference in the postoperative fever rate between the two groups [5.0% (2/40) vs. 7.5% (3/40), P=0.644]; there was also no statistically significant difference in the postoperative decrease in hemoglobin level or the length of hospital stay between the two groups [(7.8±2.8) g/L vs. (9.2±3.2) g/L, (0.78±0.29) d vs. (0.82±0.31) d, P=0.823 and 0.947]. On postoperative one month, from the CT scan, the stone free rate (SFR) in the lateral position group was higher than that in the lithotomy position group [95.0% (38/40) vs. 80.0% (32/40), P=0.043]. Conclusion　The lateral position combined with perfusion flushing and active suction clearance effect of suction sheath can significantly improve the lithotripsy efficiency of RIRS in the treatment of renal lower pole stones, shorten the operation time, and improve the postoperative SFR.

Key words: Retrograde intrarenal surgery, , Lateral position, , Lithotomy position, , Renal lower pole stones, , Stone free rate, , Complications

朱震平钟文. 侧卧位输尿管软镜碎石术治疗肾下盏结石的安全有效性分析：一项随机对照试验 [J]. 国际医药卫生导报, 2025, 31(13): 2122-2126.

Zhu Zhenping, Zhong Wen.

Analysis of the safety and efficacy of retrograde intrarenal surgery in the lateral position in the treatment of renal lower pole stones: a randomized controlled trial [J]. International Medicine and Health Guidance News, 2025, 31(13): 2122-2126.

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