“腰肋悬空”仰卧位经皮肾镜术在高危及肥胖患者中的应用

目的探讨采用一种新型体位—＂腰肋悬空＂仰卧位进行经皮肾镜碎石取石术在高危（心肺功能不全）及肥胖患者中应用的安全性及有效性。方法采用该新仰卧位进行经皮肾镜碎石术治疗肾结石20例。其中男性10例,女性10例,平均年龄（55.3±10.7）岁;结石长径2~6cm,平均（2.72±1.05）cm。其中美国麻醉师协会ASA麻醉分级Ⅲ级患者12例,肥胖患者8例;均采用椎管麻醉,在B超引导下穿刺肾盂成功后,依次扩张通道至16或20F,用钬激光或三代超声将结石完全击碎。结果所有患者均穿刺成功且均能良好耐受手术,无1例患者因体位不适提前终止手术。平均手术时间为（87.90±34.98）min。一次性结石清除率达到80%,残留结石4例,其中2例二期手术取尽结石。所有患者均未输血;无胸膜、腹腔脏器损伤等并发症发生。结论采用＂腰肋悬空卧位＂进行超声引导下经皮肾镜碎石取石术安全有效、耐受性好,临床上有很好的应用价值。

Flank suspended supine percutaneous nephrolithotomy for high-risk and obese patients

Objective To investigate the clinical significance of percutaneous nephrolithotomy（PCNL） technique in a new supine position,flank suspended,for obese patients with compromised cardiopulmonary status.Methods 20 patients,including 10 males and 10 females,underwent PCNL in a new supine position with epidural anesthesia.The average age was（55.3±10.7） years,and the average size of the stones was（2.72±1.05） cm.12 patients had an anesthesia risk of Grade 3 ASA,and other 8 patients were obese.With all patients placed in a new supine position,under ultrasound guidance,the desired calix or pelvis was punctured near the posterior auxiliary line,then the tract was dilated and the 16F or 20F tract for PCNL was established.Results Pelvicaliceal system could be successfully approached in all patients who were well tolerant.Mean operation time was（87.90±34.98） minutes.80% of the patients were rendered stone free after the initial PCNL.4 cases（20%） had residual stones,2 of which received a second PCNL to clear the residual stones.None of the patients required blood transfusion or suffered visceral injury.Conclusion The new supine PCNL is a safe and effective procedure for obese and high-risk patients.