斜仰卧-截石位经皮肾镜取石术治疗复杂性肾结石

Percutaneous nephrolithotomy in semisupine-lithotomy position for complex renal calculus

目的探讨斜仰卧-截石位经皮肾镜取石术治疗复杂性肾结石的手术方法与安全性评价。方法 2007年3月至2011年12月为686例复杂性肾结石施行斜仰卧-截石位经皮肾镜取石术。男474例,女212例,年龄47.7±12.9岁。术中在斜仰卧-截石位下先行患侧输尿管逆行插管,然后超声定位下建立16～22F的经皮肾工作通道。从经皮肾通道置入8/9.8F输尿管镜,采用气压弹道碎石器在灌注泵配合下边冲洗边碎石。记录手术时间、出血量、结石取尽率、并发症等资料,与同期施行的340例俯卧经皮肾镜取石术的临床资料相比较。结果斜仰卧-截石位经皮肾镜取石术均顺利实施,手术时间72.9±28.7min,比俯卧位经皮肾镜取石术时间缩短;术中估计出血104.3±76.6ml,输血率1.31%,结石取尽率80.6%,总体并发症发生率2.62%,与俯卧位组无统计学差异。97.7%的患者诉体位舒适,优于俯卧位组(64.1%)。结论斜仰卧-截石位施行经皮肾镜取石术治疗复杂性肾结石患者体位舒适,安全可行,并发症少;利于术中麻醉监护,提高了手术的安全性;便于术中碎石冲洗出体外,手术效果良好。

Objective To explore the surgical technique and evaluate safety of percutaneous nephrolithotomy （PCNL） in semisupine-lithotomy position for the treatment of complex renal stone. Methods Between March 2007 and December 2011, 686 patients （474 male, 212 female; mean age, 47.7±12.9 yrs） with complex renal stone underwent PCNL in semisupine-lithotomy position. With patient in semisupine-lithotomy position, retrograde ureteral catheterization was done and under ultrasonographic guidance 16-22 F percutaneous access tract was established. A 8/9.8 F rigid ureteroscope was introduced through the access tract and using pneumatic lithotripter associated with perfusion pump renal stones were disintegrated and fragments flushed out. Operation time, blood loss, stone clearance and complications were recorded and compared with those in 340 cases who underwent PCNL in prone position during same period of time. Results PCNL in semisupine-lithotomy position was successfully completed in all cases. The mean operation time was 72.9±28.7 min which was found to be comparatively lower than that in prone position. Mean estimated intraoperative blood loss was 104.3±76.6 ml, transfusion rate was 1.31%, stone clearance was 80.6% and total complication rate was 2.62%. There were no statistically significant differences between procedures in both positions. 97.7% of patients related semisupine-lithotomy position to be comfortable which was better than that in prone group （64.1%）. Conclusions PCNL in semisupine-lithotomy position for treatment of complex renal stone renders comfortable patient position. It is a safe and feasible procedure and has lower complication rate. It facilitates intraoperative anaesthesial monitoring and improves safety of surgery. It facilitates flushing out of stone fragments and has good surgical outcomes.