斜卧截石位在经皮肾镜取石术中的临床研究

目的 探讨斜卧截石位经皮肾镜取石术( percutaneous nephrolithotripsy,PCNL)治疗肾结石的安全性及有效性. 方法 采用斜卧截石位行PCNL术治疗肾结石患者75例,结石位于左侧40例,右侧35例.67例为肾盂肾盏多发结石,8例为铸型结石,结石最大径平均18.6( 15 ～65 mm).合并输尿管结石27例,结石平均最大径约12.2(9～15) mm.该体位将患侧肩部及臀部分别用沙袋垫高,使患侧向上倾斜45°,患侧下肢内收屈曲抬高置于脚架;健侧下肢屈曲置于外展的水平板上.摆放完成后患者整体成一斜卧截石位.均采用全身麻醉,B超引导下穿刺肾盂或目标肾盏成功后,依次扩张通道至F18,用钬激光碎石. 结果 本组75例患者手术均成功,无一例中转开放手术.平均手术时间(90.4 ±35.6) min.术中出血平均( 130.2±12.6) ml,均未输血.术后7例发热,予抗感染治疗后治愈,无肾盂穿孔、输尿管损伤、胸腹腔脏器损伤、败血症、休克等并发症.术后2～5d拔除肾造瘘管,术后4周拔除双J管.术后平均住院7 d.肾结石Ⅰ期取净率为93.3％.术后复查KUB,5例残留肾结石,1周后行Ⅱ期PCNL手术取净结石2例,1月后行ESWL治疗3例,结石完全清除.27例输尿管结石均Ⅰ期取净.术后75例均随访3个月,彩超复查结石排净,无明显结石残留. 结论 斜卧截石位下PCNL安全有效,患者耐受性好.

Clinical Analysis on Lithotomy Position with Lateral Tilt in Percutaneous Nephrolithotripsy

Objective To discuss the safety and efficacy of percutaneous nephrolithotripsy(PCNL) in a new operative position-lithotomy position with lateral tilt.Methods 75 patients with kidney calculi were treated by PCNL in lithotomy position with lateral tilt,including 40 patients of left lateral calculi and 37 patients of right lateral calculi.The maximum diameter of stone was 15 to 65 mm(mean 18.6mm) in 75 kidney calculi cases,including 67 cases with multiple stones in kidney pelvis and kidney calices and 8 cases with proplasm stones.Out of them,27 cases combined ureteral calculi with average 12.2 mm of maximum diameter of stones.The position held 45° lateral tilt by raising the ipsilateral shoulder and haunch with cushions,lying on lower limb unbended and buckled to the foot shelf of a surgery bed.Results All 75 cases performed PCNL successfully and appeared well tolerance.No one converse to open surgery with 90.4±35.6 minutes of average operative time and 130.2±12.6 ml of average intraoperative hemorrhage.Blood transfusion was not applied.7 cases were found high fever after operation and cured by anti-infective therapy.There was no complication such as kidney pelvis perforation,ureteral and visceral injury,septicemia,shock and so on.The renal fistulization tube was removed at 2 to 6 days and the double-J tube was removed 4 week after operation.70 cases out of the kidney patients were achieved stone free at stage one,and the one-stage clearance rate of stones was 93.3%.Five cases of kidney stones was found residual stones,and cleared by second PCNL in 2 cases and ESWL in 3 cases.All 27 cases combined ureteral stones were cleared after one-stage PCNL.All 75 cases were followed up for 3 months,and not found residual stones by KUB re-exam.Conclusion The lithotomy position with lateral tilt is safe and effective for PCNL with good tolerance in patients.