斜卧截石联合体位经皮肾镜术治疗复杂性肾结石的临床研究

目的探讨斜卧截石联合体位经皮肾镜取石术(PCNL)治疗复杂性肾结石的方法及疗效。方法 2012年6月至2016年5月我院107例复杂性肾结石患者(25例合并输尿管结石),采用斜卧截石联合体位,经超声或X线引导穿刺并建立取石通道行PCNL,术中可同时输尿管镜逆行经膀胱输尿管进行碎石,将剩余结石冲入肾盂,自经皮肾镜通道取出结石。结果所有患者均采用单通道完成手术操作。总体手术时间为95.1±26.9 min(不包括穿刺定位时间)。总体结石一次手术清除率为85.1%。其中25例合并输尿管结石的患者结石均在首次手术中清除。术后5例患者出现迟发性出血,3例患者出现严重感染。结论斜卧截石联合体位PCNL对于治疗复杂性肾结石是一种安全、有效的手术体位。相比俯卧位PCNL,该体位能够在达到相似结石清除率的同时,明显降低手术时间,利于术中麻醉监测。

The supine and lithotomy position percutaneous nephrolithotomy for complex kidney stones:Clinical experience and outcome

Objective To investigate the method and efficacy of supine and lithotomy position in complex kidney stones treated by percutaneous nephrolithotomy. Methods From June 2012 to May 2015, 107 patients with complex kidney stones underwent percutaneous nephrolithotomy in supine and lithotomy position. The access tracts were established by ultrasound or fluoroscopic guided. Then retrograde Ureteroscopy was performed to deal with the residual stones. Results All patients had a single puncture site. The average operation time were 95.1 ± 26.9 min. The total stone?free rate after the first session was 85.1%. The ureteral stones in 25 cases were cleared in the first session. Serious delayed hemorrhage was occurred in five patients. Postoperative urinary system severe infection was found in three patients. Conclusion This modified PCNL（supine and lithotomy position）is a safe and effective approach for the treatment of complex kidney stones. Compare to classic prone position, the stone clearance and complication seem to be similar, but the operation time was confirmed to be shortened.