斜仰卧截石位与俯卧位经中上盏入路微通道经皮肾镜的比较

Comparison of minimally-invasive percutaneous nephrolithotomy via middle and upper calyx approach in oblique supine lithotomy position and prone position

目的 比较斜仰卧截石位与俯卧位经中上盏入路行微通道经皮肾镜碎石取石术(MPCNL)治疗上尿路结石的安全性及疗效,探究斜仰卧截石位经中上盏入路的临床应用优势。方法 选取2018年3月至2020年5月超声引导下经中上盏入路行MPNCL术患者95例,并回顾其临床资料。根据手术体位不同分为斜仰卧组(49例,采用斜仰卧截石位经中上盏入路行MPNCL)与俯卧组(46例,采用俯卧位经中上盏入路行MPNCL)。比较术中体位舒适度等围手术指标、血清指标变化值、手术相关并发症情况以及一次性结石清除率与结石总清除率。结果 两组性别、年龄、BMI、结石大小、结石位置、结石数目、结石侧别、积水程度、术前合并症、解剖异常等基线资料比较,差异均无统计学意义(P均>0.05)。斜仰卧组术中整体舒适度明显优于俯卧组,差异具有统计学意义(P<0.05);斜仰卧组建立通道时间、手术时间及住院时间均明显短于俯卧组,差异均具有统计学意义(P均<0.05);斜仰卧组血红蛋白变化值、血清尿素变化值、血肌酐变化值、血β2-微球蛋白变化值均明显小于俯卧组,差异均具有统计学意义(P均<0.05);斜仰卧组手术相关并发症发生率(12.2%)明显低于俯卧组(32.6%),差异具有统计学意义(P<0.05)。斜仰卧组一次性结石清除率(89.8%)、结石总清除率(95.9%)均明显高于俯卧组(69.6%、76.1%),差异均具有统计学意义(P均<0.05)。结论 相较于俯卧位,斜仰卧截石位经中上盏入路行MPNCL治疗上尿路结石,能够有效减轻术中体位不适感,减少术中出血量,缩短手术时间,减少肾损伤,有利于术后恢复,且相关并发症少,结石清除率高,安全性高,是可供选择的经皮肾镜碎石取石术体位。

Objective To compare the efficacy and safety of minimally-invasive percutaneous nephrolithotomy(MPCNL)via middle and upper calyx approach in the treatment of upper urinary tract calculi in different positions(oblique supine lithotomy position and prone position),and to explore the advantages of clinical application of oblique supine lithotomy via middle and upper calyx approach.Methods Ninety-five patients who underwent ultrasound-guided MPNCL via the middle and upper calyx from March 2018 to May 2020 were selected and their clinical data were reviewed.They were divided into oblique supine group(49 cases,MPNCL via middle and upper calyx approach using oblique supine lithotomy position)and prone group(46 cases,MPNCL via middle and upper calyx approach using prone position)according to different positions of surgery.Perioperative parameters such as intraoperative postural comfort,changes in serum parameters,surgery-related complications,and one-time combined clearance rate and total stone clearance rate were compared.Results There was no significant difference in gender,age,BMI,stone size,stone location,stone number,stone side,degree of hydronephrosis,preoperative complications,anatomical abnormalities and other baseline data between the two groups(all P>0.05).The overall intraoperative comfort in the oblique supine group was better than that in the prone group were(P<0.05);the channel establishment time,operation time and hospital stay in the oblique supine group were less than those in the prone group(all P<0.05);the hemoglobin change value,serum urea change value,serum creatinine change value and serumβ2-microglobulin change in the oblique supine group were less than those in the prone group(all P<0.05);the incidence rate of surgery-related complications in the oblique supine group(12.2%)was lower than that in the prone group(32.6%)(P<0.05).The one-time stone clearance rate(89.8%)and total stone clearance rate(95.9%)in the oblique supine group were higher than those in the prone group(69.6%,76.1%)(all P<0.05).Conclusion Compared with prone position,MPNCL via middle and upper calyx in oblique supine lithotomy position can effectively reduce intraoperative postural discomfort,reduce intraoperative blood loss,shorten operation time and reduce renal injury,which is beneficial to postoperative recovery,with less related complications,high stone clearance rate and high safety.It is an alternative nephrolithotomy position.