半截石斜侧卧位的建立及在经皮肾镜碎石取石术中的临床研究

The establishment and clinical application of imcomplete lithotomic and inclined side-lying position in percutaneous nephrolithotomy

目的:建立一种经皮肾镜碎石取石术(PCNL)新型手术体位——半截石斜侧卧位。方法:从2010年11月至2012年8月采用半截石斜侧卧位行PCNL术患者97例。半截石斜侧卧位体位:垫高患侧肩和臀部使身体向健侧倾斜30°～45°左右;健侧下肢利用腿架使髋关节外展,屈髋,屈膝;患侧下肢外展并放于手术床上利用手术台腿板外展15°～20°左右;健侧腰下垫软垫,使整个腰部抬高10～20cm左右,呈被动折刀位。结果:97例均穿刺成功,患者能良好耐受手术,术中血压及心率较为平稳,术中平均动脉压差为(14.7±6.0)mmHg,平均心率差为(13.5±6.0)次/min,无胸膜或腹腔脏器损伤等并发症发生。平均手术时间(81.1±25.3)min,一期结石取净率80.4%(78/97),术后住院时间(5.8±3.7)d,手术后平均血红蛋白降低(9.8±10.2)g/L,术后无患者需输血。结论:半截石斜侧卧位下行PCNL术安全有效,耐受性好。

Objective To establish a new operation position during percutaneous nephrolithotomy（PCNL）：imcomplete lithotomic and inclined side-lying position.Methods 97 patients were treated with PCNL in imcomplete lithotomic and inclined side-lying position form Nov 2010 to Aug 2012.Imcomplete lithotomic and inclined side-lying position was：to make the body incline to the normal side about 30°-45° by raising the unnormal side shoulder and haunch.To make hip joint abduction by leg frame in the normal side lower limb and to bend coxa and knees.To make another lower limb abduction of 15°-20° by operation table leg plate.To raise the haunch with cushion so as to make the whole lumbar elevated about 10-20 cm and to make it to a passive knife bit.Results All cases were punctured successfully and well tolerated.The mean of intraoperative fluctuation of blood pressure and heart rate were relatively stable.There was no pleural infection,abdominal viscera＇s damage,or other complications.The mean operation time was（81.1 ± 25.3）min.80.4%（78 /97）of patients was rendered free of stones by the initial PCNL.The postoperative hospitalization time was（5.8 ± 3.7）d and the decrease of hemoglobin was（9.8 ± 10.2）g /L after surgery.No patient needed postoperative blood transfusion.Conclusions The imcomplete lithotomic and inclined side-lying position was safe and effective for PCNL.And the new position had more advantages as compared with the prone or traditional supine position