半截石卧位和俯卧位经皮肾镜取石术的疗效比较

Comparison of curative effect of semi-lithotomic supine position with prone position in percutaneous nephrolithotomy

目的比较半截石卧位和俯卧位经皮肾镜取石术的疗效和安全性。方法将68例肾结石或(并)输尿管上段结石患者随机分成2组,分别在半截石卧位(33例)和俯卧位(35例)实施经皮肾镜取石术,对2组病例的术中出血量、手术时间、工作通道数、Ⅰ期结石清除率、住院时间、手术并发症等进行比较。结果 68例手术均获成功,无穿刺失败和中转开放手术者,无肠管损伤、气胸、大出血等严重并发症。半截石卧位、俯卧位手术时间分别是(73.6±27.5)min及(98.5±30.8)min,差异有统计学意义(P<0.05);而在手术出血量、工作通道、Ⅰ期结石清除率、术后肾造瘘管留置时间、住院时间、并发症等方面比较差异无统计学意义(P>0.05)。结论半截石卧位施行经皮肾镜取石术具有高效、安全、体位舒适、灵活性强、省时等优点,有良好的推广前景。

Objective To compare the efficacy and safety of semi-lithotomic supine position with prone position in percutaneous nephrolithotomy（PCNL）. Methods Sixty-eight cases of renal stones or （and） upper ureteral stones scheduled to undergo NL were divided into semi-lithotomic supine position group （n=33） or prone position group（n=35） randomly. Operation blood loss, and operation time, orking channel, stone clearance on stage I, stay time of hospital, operative complication were compared between the two groups. Results PCNL were completed successfully in 68 patients, with no serious postoperative complications such as intestinal injury, pneumothorax, or massive haemorrhage occurred. Average operation duration was （73.6±27.5） min for the semi-lithotomic supine position group, and （98.5±30.8） min for the prone position group, with a significant difference between the two groups. There was no significant difference in the operation blood loss, working channel, stone clearance on stage I, postoperative renal fistula indwelling time, stay time of hospital, or operative complications between the two groups（P＞0.05）.Conclusion The semi-lithotomic supine position in PCNL is safe, effective, comfortable, flexible, and time saving ,and it is worthy of clinical application.