"蛙泳"俯卧位在经皮肾镜术中的应用

Clinical application of breaststroke prone position in percutaneous nephrolithotomy

目的对比"蛙泳"俯卧位与传统俯卧位对经皮肾镜碎石取石术(PCNL)治疗上尿路结石的安全性和有效性。方法回顾性分析2019年6月至2020年6月期间在中山大学附属第五医院接受PCNL手术的147例肾结石和输尿管上段结石患者的临床资料,按术中采取的手术体位不同,将患者分为"蛙泳"俯卧位组("蛙泳"组)和传统俯卧位组(传统组)。比较两组患者左侧第12肋下缘至肾最下缘的距离、腰背部体表至肾后缘平面的距离、建立通道时间、手术时间、多通道使用率、并发症发生率及结石清除率等。结果与传统组相比,"蛙泳"组第12肋下缘至肾最下缘间距更长(P=0.006)、腰背部体表至肾后缘平面的间距更短(P=0.020),建立通道时间短(P<0.001),手术时间更短(P=0.031),多通道使用率降低(P=0.027)。两组患者之间结石清除率(P=0.751)、并发症发生率(P=0.109)、总住院时间(P=0.188)差异无统计学意义。结论治疗上尿路结石采用"蛙泳"俯卧位有利于提高经皮肾镜碎石取石术的效率。

ObjectiveTo compare the safety and effect of breaststroke position and traditional prone position of percutaneous nephrolithotomy (PCNL) in the treatment of upper urinary tract calculi.MethodsThe clinical data of 147 patients with renal calculi or upper ureteral calculi who underwent PCNL surgery in the Fifth Affiliated Hospital of Sun Yat-sen University from June 2019 to June 2020 were analyzed retrospectively. According to the different surgical positions during the operation, the patients were divided into the breaststroke position group and the traditional prone position group. The distance from the lower edge of the left twelfth rib to the lowest edge of the kidney, the distance from the back of the waist to the posterior edge of the kidney, the time to establish the channel, the operation time, the rate of multi-channel, the incidence of complications and the stone removal rate were compared between the two groups.ResultsCompared with the traditional position group, in the breaststroke position group, the distance from the lower edge of the 12th rib to the lowest edge of the kidney was longer (P=0.006), the distance from the body surface of the back of the waist to the plane of the posterior edge of the kidney was shorter (P=0.020), the time to establish the channel was shorter (P<0.001), the operation time was shorter (P=0.031), and the rate of multi-channel was lower (P=0.027). There were no significant differences in stone clearance rate (P=0.751), complication rate (P=0.109), and total length of hospital stay (P=0.188) between the two groups.ConclusionIn the treatment of upper urinary tract calculi, the breaststroke position can improve the efficiency of PCNL.