斜仰卧位经皮肾镜取石术治疗高危上尿路结石的疗效观察

Clinical efficacy of percutaneous nephrolithotomy in oblique supine position in high-risk patients with upper urinary tract stones

目的探讨采取斜仰卧位经皮肾镜取石术治疗高危患者上尿路结石的临床疗效及安全性。方法回顾分析采取斜仰卧位超声引导下经皮肾镜取石术治疗的85例高危上尿路结石患者的临床资料,对手术时间、术中出血量、清石率、术后住院日及并发症等情况进行分析。其中男60例,女25例,肾结石70例,输尿管上段结石15例。结果入组高危患者共85例,均采用斜仰卧位超声引导下经皮肾镜取石术,所有患者手术均获得成功,结石Ⅰ期取净78例(91.76%),Ⅱ期取净5例(5.88%),2例(2.35%)患者存在残石,3例(3.53%)术后活动性出血。无气胸、结肠损伤或中转开放等并发症。结论采取斜仰卧位超声引导下经皮肾镜取石术治疗高危上尿路结石安全有效,并且患者耐受性好,便于麻醉管理,对于高危患者是一种值得推荐的手术体位。

Objective To investigate the clinical efficacy and safety of percutaneous nephrolithotomy in oblique supine position in high-risk patients with upper urinary tract stones. Methods 85 high-risk patients including 60 males and 25 females. 70 patients with renal stones, and 15 patients with upper ureteral stones respectively underwent ultrasound-guided percutaneous nephrolithotomy in oblique supine position. Operative time, stone-free rate, blood loss, postoperative hospital stay and complication rate were obtained from medical records. Results 85 patients with renal or upper ureteral stones were included in our study. The stone-free rates were 91.76% and 5.88% in stage I and II respectively. Residual stone was found in 2 patients, and postoperative bleeding was found in 3 patients. No severe complication such as pneumothorax, colon injury or conversion to open surgery was observed. Conclusions Percutaneous nephrolithotomy in oblique supine position was effective and safe for patients with upper urinary tract stones, especially for those high-risk patients who poorly tolerate anesthesia and percutaneous nephrolithotomy in prone position.