半截石斜侧卧位在经皮肾镜碎石术中的应用

Application of imcomplete lithotomic and inclined side-lying position in percutaneous nephrolithotomy

目的研究半截石斜侧卧位下行经皮肾镜碎石术(PCNL)治疗肾和输尿管上段结石的安全性及有效性。方法采用半截石斜侧卧位行PCNL术治疗泌尿系结石患者28例(组1),传统俯卧位行PCNL术30例(组2),比较两组间术后住院时间、血压波动情况、手术前后血红蛋白差、手术时间及结石清除率等情况。结果 58例均穿刺成功,均无感染、胸膜或腹腔脏器损伤等并发症发生,组1的术中血压波动比组2平稳(P=0.002),手术时间缩短(P=0.054),结石清除率、手术前后血红蛋白差、术后住院时间差异均无显著性。结论半截石斜侧卧位下行PCNL术,利于碎石冲出、减少护士的工作量缩短手术时间,利于麻醉医生术中的管理,更加安全,患者耐受性好。

【Objective】 To evaluate the safety and efficacy of PCNL in imcomplete lithotomic and inclined side-lying position for renal calculi and upper ureteral stones.【Methods】 28 patients treated with PCNL in imcomplete lithotomic and inclined side-lying position were in group 1,30 cases in traditional prone position were in group 2,between the two groups postoperative hospitalization time,fluctuation of blood pressure,hemoglobin difference before and after the surgery,operation time and stone-free rate were compared.【Results】 All cases were punctured successfully.There are no pleural infection or abdominal viscera＇s damage,and other complications.Intraoperative fluctuation of blood pressure in the group 1 was more stably than group 2（P =0.002）,the operation time was shortened（P =0.054）.There were no significant differences in postoperative hospitalization time,hemoglobin difference before and after the surgery and stone-free rate.【Conclusion】 PCNL in imcomplete lithotomic and inclined side-lying position is more secure and effective than in traditional prone position,which are beneficial to rush out the gravel,decrease the nurse＇s workload,reduce operating time,and easy to manage in operation for anesthetist.