目的:输尿管镜激光碎石术(URSLL)中结石碎片的逆行对泌尿科医师来说仍然是一个挑战,并且与增加的手术时间和降低的无结石率(SFR)相关。在这里,我们比较了标准背侧切开取石位(SDL)和背侧切开取石位与反向Trendelenburg(RT)的URSLL期间输尿管结石的后推率材料和方法:2019年5月至2022年1月,需要手术干预的输尿管结石患者随机接受SDL或RT位置的URSLL.该研究的主要结果是结石逆行的发生。次要结果包括向肾脏逆行,SFR,手术时间,30天ED访视和并发症,以及从半刚性输尿管镜转换为柔性输尿管镜的需要。使用卡方检验评估组间差异,费希尔的精确检验,Kruskal-Wallis测试,或t检验。
结果:共纳入114例患者,每组57例患者。在基线人口统计学或结石特征方面,组间没有差异。RT组的逆行频率明显较低(68.4%vs.10.5%,p<0.01)。同样,RT组有利于降低向肾脏逆行的风险(40.4%vs.5.3%,p<0.01),手术时间(43.5minvs.33.0分钟,p=0.02),并需要输尿管镜转换(16.7%与2.2%,p=0.04)。SFR没有差异(100%与95%,p=0.49)。
结论:在输尿管结石的URSLL期间的RT定位显着降低了结石的倒排率,手术时间,以及从半刚性输尿管镜转换为柔性输尿管镜的需要。
Purpose: Retropulsion of stone fragments during ureteroscopic laser lithotripsy (URSLL) remains a challenge for urologists and is associated with increased operative time and reduced stone-free rate (SFR). In this
study, we compared the rate of retropulsion of ureteral stones during URSLL between the standard dorsal lithotomy (SDL) position and dorsal lithotomy position with reverse Trendelenburg (RT). Materials and Methods: Patients with ureteral stones requiring surgical intervention between May 2019 and January 2022 were randomized to undergo URSLL in either SDL or RT positions. The primary outcome of this
study was stone retropulsion. Secondary outcomes included retropulsion to the kidney, SFR, operative time, 30-day emergency department visits and complications, and the need for conversion from semirigid to flexible ureteroscope. Differences between groups were evaluated using the chi-square test, Fisher exact test, Kruskal-Wallis test, or t-test. Results: A total of 114 patients were included in the
study, with 57 patients in each group. There were no differences between groups in terms of baseline demographics or stone characteristics. Retropulsion was significantly less frequent in the RT group (68.4% vs 10.5%, p < 0.01). Similarly, the RT group was favored for lower risk of retropulsion into the kidney (40.4% vs 5.3%, p < 0.01), operative time (43.5 vs 33.0 minutes, p = 0.02), and need for ureteroscope conversion (16.7% vs 2.2%, p = 0.04). There was no difference in the SFR (100% vs 95%, p = 0.49). Conclusions: RT positioning during URSLL for ureteral stones significantly decreases the rate of stone retropulsion, operative time, and the need for conversion from semirigid to flexible ureteroscope.