女性斜卧截石位与俯卧位经皮肾镜的比较

A comparative study between recumbent and lithotomy position and prone position in percutaneous nephrolithtomy in female

目的探讨斜卧截石位经皮肾镜弹道碎石术的临床应用价值。方法选择高州市中医院泌尿外科2010年3月至2013年3月女性肾结石患者30例,随机分成2组,试验组斜卧截石位15例,对照组俯卧位15例,超声引导下行微创经皮肾镜碎石取石术,监测记录手术开始到穿刺成功的时间、手术开始到手术完全结束的时间、结石取净率、术中出血量、术中患者舒适度及手术并发症等,并进行统计学分析。结果两组患者间年龄、结石大小、身体质量指数(BMI)差异均无统计学意义(P>0.05),两组手术均获成功。试验组手术开始到穿刺成功的平均时间明显短于对照组[(15±3)min vs(30±7)min,P=0.004)],手术开始到手术完全结束的时间也短于对照组[(87±20)min vs(125±25)min,P=0.002)],两组患者术中舒适度(P=0.001)及变换麻醉方式(P=0.031)差异也有明显统计学意义。而结石取净率(试验组86.7%vs对照组73.3%,P=0.361)、术中出血[试验组(65±20)ml vs对照组(60±18)ml,P=0.875)]及并发症发生率(P=0.666)均无统计学差异。结论斜卧截石位经皮肾镜术可明显缩短手术时间,术中患者舒适度高,增加了手术的安全性,值得临床推广应用。

ObijectiveTo investigate the clinical value of recumbent and lithotomy position inpereutaneous nephrolithtomy.methods From March 2010 to March 2013, a total of 30 cases female patientswith renal stone were collected in Chinese Medicine Hospital of Gaozhou. They were randomly divided into two groups, 15 cases in recumbent and lithotomy position and other 15 cases in prone position. The patients underwent PCNL via B-ultrasound guidance. The operative time, stone clearanee rate, blood loss, comfortdegree and complications were analyzed.Resuit There were no statistical differences in age, size of stoneand body mass index between the two groups. There were statistical difference in operative time from beginning to achievement of puncture, （15＋3） min in recumbent and lithotomy position and （30＋7） min in prone position （P-~0.004）. There were statistical differences in total operative time, （87~20） min in recumbent and lithotomy position and （125±25） min in prone position （/＇=-0.002）. There were statistical differences in comfort degree （P=-0.001） and the convert rate to general anesthesia （P=0.031）. But there were no statistical differences in blood loss [（65±20） ml vs （60±18） ml, P--0.875], stone clearance rate （86.7% vs 73.3%,P=0.361） and complication （P--0.666） between the two groups.ConclusionIn recumbent and lithotomyposition, the operative time ofpercutaneous nephrolithtomy is shorter, and the patients are more comfortable during operation. The position is worth applying.