半截石斜侧卧位经皮肾镜碎石术在复杂性肾结石中的临床应用

Application of percutaneous nephrolithotomy with oblique lateral position in the treatment of complex renal calculi

目的:研究半截石斜侧卧位经皮肾镜碎石术(PCNL)治疗复杂性肾结石的安全性和有效性。方法:选取2015年4月至2019年12月广西河池市第三人民医院收治的复杂性肾结石患者120例,按随机数字表法分为观察组(60例)和对照组(60例),观察组采用半截石斜侧卧位行PCNL,对照组采用俯卧位行PCNL,对比分析两组设置体位前5 min(T_(0))、设置体位后5 min(T_(1))、设置体位后30 min(T_(2))及手术后5 min(T_(3))的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))。同时,对两组患者建立通道时间、手术时间、术中出血量、一次清石率、住院时间、术后并发症及患者舒适度情况进行比较。结果:观察组T_(1)、T_(2)、T_(3)时点MAP均高于对照组,T_(2)、T_(3)时点HR均低于对照组,T_(1)、T_(2)时点SpO_(2)均明显高于对照组(均P<0.05)。观察组手术时间短于对照组,术中出血量低于对照组(P<0.05),且观察组患者术中舒适度明显优于对照组(P<0.05)。两组建立通道时间、一次清石率、住院时间及并发症发生率比较,差异无统计学意义(P>0.05)。结论:半截石斜侧卧位PCNL技术疗效确切,安全可行,值得临床推广应用。

Objective:To investigate the effect of percutaneous nephrolithotomy with oblique lateral(PCNL)position in the treatment of complex renal calculi.Methods:A total of 120 patients with complex renal calculi admitted to our hospital from April 2015 to December 2019 were selected,and randomly divided into an observation group and a control group,with 60 cases in each group.The patients in the observation group received PCNL in the semi lateral position,while those in the control group received PCNL in prone position.The mean arterial pressure(MAP),heart rate(HR)and blood oxygen saturation(SpO_(2))were compared between the two groups at 5 min before placement(T_(0)),5 min after placement(T_(1)),30 min(T_(2))and 5 min after operation(T_(3)).The channel establishment time,operation time,intraoperative blood loss,stone removal rate,hospital days,postoperative complications and patient comfort were compared as well.Results:MAP of the observation group at T_(1),T_(2)and T_(3)were higher than that of the control group,but HR at T2 and T3 were lower;moreover,SpO_(2)at T_(1)and T_(2)were significantly higher(P<0.05).The operation time and intraoperative blood loss in the observation group were significantly lower than those in the control group,and the intraoperative comfort of the observation group was significantly better(P<0.05).There was no significant difference in the time of establishing passage,the rate of stone removal and hospital days between the two groups(P>0.05).Conclusion:PCNL technique of hemilithotomy and hemilateral position is effective and safe,which is worthy of clinical application.