斜仰卧位经皮肾镜治疗上尿路结石

目的探讨斜仰卧位经皮肾取石术（PCNL）治疗上尿路结石的安全性和有效性。方法2004年6月至2008年6月，采用斜仰卧位PCNL治疗上尿路结石126例，其中肾结石77例，输尿管上段结石合并肾盏结石15例，单纯输尿管上段结石34例。患者取斜仰卧位，垫高患侧肩和臀部使身体倾斜30°～45°。超声引导经腋后线12肋下或11肋间穿刺肾脏建立通道。采用气压弹道碎石行一次或分次清除结石。结果126例患者共接受141次PCNL治疗。49例输尿管上段结石和62例肾结石一期PCNL清除结石，一次碎石成功率为88．1％。15例复杂性肾结石因残石需行二期PCNL。平均手术时间为（117±24）min。11例患者因术中或术后大出血需输血治疗，输血率8．7％。无肠道或胸膜损伤并发症发生。结论采用斜仰卧位PCNL治疗上尿路结石安全有效、操作方便，可明显提高患者手术耐受性，值得临床推广应用。

Percutaneous nephrolithotomy in supine position

Objective To evaluate the technique of PCNL in supine antero- lateral position. Methods From June 2004 to June 2008, we treated 126 patients including 77 cases of renal calculi,49 upper ureteral calculi or with calyx calculi. The supine position was obtained with ipsilateral shoulder and gluteus elevating about 30 to 45 degree. Ultrasound-guided puncture toward the middle calices was done. Pneumatic power treated the calculi in one or some procedures. Results 126 cases underwent 141 PCNLs. All ureteral and 88.1% of renal calculi were accomplished in 1 procedure. 15 cases of complex renal calculi needed 2 procedures. The mean operative time was 117_＋24 rains. 11 （8.7%） cases needed blood transfusion. No injury of adjacent organ was observed. Conclusions The technique of PCNL with the patient in supine anterolateral position could be safe, effective, easy-doing and worth to spread.