改良俯卧位经皮肾镜取石术治疗上尿路结石

Percutaneous nephrolithotomy in modified prone position for patients with upper urinary calculi

目的:探讨改良俯卧位经皮肾镜取石术(PCNL)治疗上尿路结石的安全性和有效性。方法:回顾性分析2016年11月~2019年8月我院采用改良俯卧位PCNL(部分联合输尿管镜)治疗上尿路结石296例患者的临床资料,其中肾结石242例,输尿管中下段结石合并肾结石48例,输尿管结石合并输尿管严重扭曲6例。手术均采用椎管内麻醉,并在改良俯卧位下先行输尿管镜检置管或输尿管镜碎石,然后在B超定位下作PCNL。结果:296例患者均在该体位下完成PCNL,一期术后结石清石率(SFR)为95.9%,平均手术时间为(68.1±18.3)min。12例复杂性肾结石因残石行了二期PCNL或输尿管软镜碎石术(RIRS)或体外冲击波碎石术(ESWL),2例患者因术后出血调整气囊尿管压迫3 d后成功止血,未进行输血治疗。无肠道或胸膜等重要脏器损伤并发症发生。结论:采用改良俯卧位PCNL治疗上尿路结石安全有效,可联合输尿管硬/软镜手术,术中无需更换体位,提高SFR的同时也缩短了手术时间,值得临床推广应用。

Objective:To explore the safety and efficacy of percutaneous nephrolithotomy(PCNL)in modified prone position for patients with upper urinary calculi.Method:From November 2016 to August 2019,296 cases of upper urinary calculi underwent PCNL in the prone split-leg position under spinal anesthesia.There were 242 cases of kidney stones,48 cases of middle and lower ureteral stones combined with kidney stones,6 cases of ureteral stones combined with severe ureteral distortion.Result:All procedures were performed successfully with PCNL in modified prone position.The stone-free rate(SFR)was 95.9%.The mean operation time was(68.1±18.3)min.Twelve patients received the secondary PCNL/RIRS/ESWL.Two patients of postoperative bleeding succeeded in hemostasis after 3 days through balloon compression.No complications or organ injury occurred.Conclusion:PCNL in modified prone position is a viable approach for patients with upper urinary calculi.It can improve SFR and shorten operation time without changing body position,so is worthy of clinical application.