斜跨位与俯卧位经皮肾镜取石术治疗老年肾及输尿管上段结石患者的疗效比较

Comparison of curative effect of percutaneous nephrolithotomy between oblique supine position and prone position in the treat⁃ment of renal and upper ureteral stones in elderly patients

目的比较斜跨位(即斜仰卧-截石位)与俯卧位经皮肾镜取石术治疗老年患者上尿路结石的有效性及安全性。方法回顾性分析2021年4月—2023年1月在复旦大学附属华东医院泌尿外科行经皮肾镜取石术的100例老年肾和输尿管上段结石病例资料,术中体位采用斜跨位患者设为观察组,采用俯卧位患者设为对照组。比较2组基线情况、手术时间、术中气道压、住院时间、结石清除率及并发症等情况。结果所有病例均采用单一通道经皮肾镜取石术(PCNL)完成手术,观察组6例因结石无法触及原因Ⅰ期联合输尿管软镜碎石;对照组5例因结石下行至输尿管下段术中更换截石位完成手术。2组术中均无胸膜损伤、结肠损伤、肾盂穿孔病例,无术后失血性、感染性休克等严重并发症。2组年龄、性别、结石大小等基线情况差异无统计学意义。观察组手术前后血红蛋白差值(13.88±3.31)g/L,手术前后血白细胞差值(4.92±1.96)×10^(9)/L,平均住院时间(6.12±1.17)d,术后1个月结石清除率(92.30%)与对照组相比差异均无统计学意义。但观察组手术时间(74.94±11.58)min少于对照组(84.10+7.08)min(P<0.001)。观察组术中气道压(12.98±0.47)cmH_(2)O低于对照组(16.62±0.47)cmH_(2)O(P<0.001)。2组总并发症差异无统计学意义(P=0.313)。结论斜跨位经皮肾镜取石术较传统俯卧位手术疗效相似,术中安全性高,可缩短手术时间,降低老年患者围术期风险,是处理肾脏及输尿管上段结石的优选术式。

Objective To compare the efficacy and safety of percutaneous nephrolithotomy(PCNL)in oblique supine position(oblique supine⁃lithotomy position)and prone position in the treatment of renal and upper ureteral stones in elderly pa⁃tients.Methods The data of 100 elderly patients with renal and upper ureteral stones who underwent PCNL in Department of U⁃rology,Huadong Hospital Affiliated to Fudan University from April 2021 to January 2023 were retrospectively analyzed.Dur⁃ing the operation,patients in the observation group took the oblique supine position and patients in the control group took the prone position.The baseline condition,operation time,intraoperative airway pressure,hospital stay,stone clearance rate and complications were compared between the two groups.Results All patients were treated with single⁃channel PCNL.In the ob⁃servation group,6 cases were treated with stage I combined with ureteral soft lithotripsy due to untouchable calculi.In the control group,5 ones were transferred to lithotomy position and completed the operation due to the stone descent to the lower seg⁃ment of the ureter.There were no cases of pleural injury,colon injury,or renal pelvis perforation during the surgery in both groups.There were no serious complications such as postoperative hemorrhagic and septic shock.There was no statistically sig⁃nificant difference in baseline conditions such as age,gender,and stone size between the two groups.In the observation group,the difference of hemoglobin before and after operation was(13.88±3.31)g/L,the difference of white blood cells before and after operation was(4.92±1.96×)10^(9)/L,the average length of hospital stay was(6.12±1.17)d,and the stone clearance rate one month after operation was 92.30%,and they were not significantly different from those in the control group.However,the operative time of the observation group(74.94±11.58)min was shorter than that of the control group(84.10+7.08)min(P<0.001),and the intraoperative airway pressure(12.98±0.47)cmH_(2)O was lower than that of the control group(16.62±0.47)cmH_(2)O(P<0.001).There was no significant difference in the total complications between the two groups(P=0.313).Conclusion The therapeutic effect of PCNL in oblique supine position is similar to that in traditional prone posi⁃tion.It has high intraoperative safety,can shorten surgical time,and reduce perioperative risk in elderly patients.It is a pre⁃ferred surgical method for treating renal and upper ureteral stones.