腰肋悬空仰卧位下经皮肾镜取石术的临床研究

目的 研究腰肋悬空仰卧位下PCNL治疗肾和输尿管上段结石的安全性及有效性.方法2010年3-10月采用腰肋悬空仰卧位PCNL治疗泌尿系结石患者173例.平均年龄(50±11)岁.结石位于左侧70例,右侧97例,双侧6例.肾结石166例,输尿管上段结石7例.结石最大径1.5～6.0 cm,平均(2.9±1.0)cm.该体位将患侧肩部及臀部分别用3 L水袋或气囊垫高,使患侧腰肋部悬空,同时建立腰桥.均采用椎管麻醉,B超引导下穿刺肾盂或目标肾盏成功后,依次扩张通道至16 F或20 F,用钬激光或EMS碎石清石系统碎石. 结果 173例均穿刺成功并能良好耐受手术,患者无因体位不适终止手术者.平均手术时间(86±34)min.一次性结石清除率为80.3%(139/173),残留结石34例,其中行二期手术取净结石16例.术后输血治疗1例;无胸膜、腹腔脏器损伤等并发症发生. 结论腰肋悬空仰卧位下PCNL安全有效,患者耐受性好.

Abstract：

Objective To investigate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in a new operative position, flank suspended supine position. Methods The new position hold affected flank suspended by raising the ipsilateral shoulder and haunch with two 3-liter saline bags, and set up waist bridge simultaneously. From March 2010 to October 2010, a series of 173 patients underwent PCNL with the new supine position under epidural anesthesia. The average age was (50± 11) years, and the average bulk of the stone was (2. 9±1.0) cm. All patients were placed in the new supine position. Under ultrasound guidance, the desired calix or pelvis was punctured near the posterior axillary line, then dilating the tract and establishing the 16 F or 20 F tract for PCNL. Results The pelvicaliceal system could be successfully approached in all patients. The procedure was well tolerated in all patients. Mean operation time was (86 ± 34) min. 80. 3% of the patients were rendered free of stones by the initial PCNL. Thirty-four cases had residual stones, and a second PCNL was performed in 16 cases to clear the residual stones. Only 1 patient required blood transfusion.None of the patients suffered visceral injury. Conclusion The new supine position is safe and effective for PCNL.

Application of flank suspended supine position in percutaneous nephrolithotomy

Objective To investigate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in a new operative position, flank suspended supine position. Methods The new position hold affected flank suspended by raising the ipsilateral shoulder and haunch with two 3-liter saline bags, and set up waist bridge simultaneously. From March 2010 to October 2010, a series of 173 patients underwent PCNL with the new supine position under epidural anesthesia. The average age was (50± 11) years, and the average bulk of the stone was (2. 9±1.0) cm. All patients were placed in the new supine position. Under ultrasound guidance, the desired calix or pelvis was punctured near the posterior axillary line, then dilating the tract and establishing the 16 F or 20 F tract for PCNL. Results The pelvicaliceal system could be successfully approached in all patients. The procedure was well tolerated in all patients. Mean operation time was (86 ± 34) min. 80. 3% of the patients were rendered free of stones by the initial PCNL. Thirty-four cases had residual stones, and a second PCNL was performed in 16 cases to clear the residual stones. Only 1 patient required blood transfusion.None of the patients suffered visceral injury. Conclusion The new supine position is safe and effective for PCNL.