不同体位对经皮肾镜碎石取石术治疗效果的影响

Influence of Different Body Positions on Treatment Effect of Percutaneous Nephrolithotomy

目的:研究不同体位对经皮肾镜碎石取石术(PCNL)治疗肾结石效果的影响。方法:选取2019年6月-2020年3月广西壮族自治区民族医院收治的60例行PCNL的患者作为研究对象,按照手术体位的不同将患者分为三组,各20例。三组患者均行PCNL。比较三组患者术后并发症发生率、手术指标、肾功能指标及应激指标。结果:三组并发症总发生率比较,差异无统计学意义(P>0.05);三组一期净石率比较,差异无统计学意义(P>0.05);45°斜仰卧位组手术时间及住院时间均短于俯卧位组及侧卧位组,术中出血量少于俯卧位组及侧卧位组,差异有统计学意义(P<0.05);三组患者术前、术后1周的血尿素氮和血肌酐水平比较,差异无统计学意义(P>0.05);三组患者术前、术后1 d的血清皮质醇和去甲肾上腺素水平比较,差异无统计学意义(P>0.05)。结论:对于PCNL患者取45°斜仰卧位,能够缩短手术时间及住院时间,减少术中出血量,值得应用。

Objective: To investigate the influence of different body positions on treatment effect of percutaneous nephrolithotripsy (PCNL) for renal calculi. Methods: A total of 60 patients with PCNL who were admitted to the Minzu Hospital of Guangxi Zhuang Autonomous Region from June 2019 to March 2020 were selected as the study subjects, and the patients were divided into three groups according to different surgical positions, with 20 cases in each group. All three groups of patients underwent PCNL. The incidence of postoperative complications, surgical indicators, renal function indicators and stress indicators were compared among the three groups. Results: There was no significant difference in the total incidence of complications among the three groups (P> 0.05);there was no significant difference in the first-stage stone removal rate among the three groups (P>0.05);the operative time and hospitalization time in the 45° oblique supine position group were shorter than those in the prone position group and the lateral position group, and the intraoperative blood loss was less than that in the prone position group and the lateral position group, and the difference was statistically significant (P<0.05). There was no significant difference in blood urea nitrogen and serum creatinine levels between the three groups before and one day after surgery (P>0.05);there was no significant difference in serum cortisol and norepinephrine levels between the three groups before and one day after surgery (P>0.05). Conclusion: For PCNL patients, the 45° oblique supine position can shorten the operation time and hospital stay, and reduce the amount of intraoperative blood loss, which is worthy of application.