斜仰截石位下经皮肾镜取石术的临床研究

目的 研究斜仰截石位经皮肾镜取石术( percutaneous nephrolithotomy,PCNL)治疗肾和输尿管上段结石的临床价值. 方法 采用斜仰截石位行PCNL治疗肾输尿管结石患者68例,其中肾结石28例,输尿管上段结石40例.结石最大径平均(2.1 ±1.6) cm. 结果 本组68例患者均手术成功,无一例中转开放手术.采用单通道64例,双通道4例.平均手术时间(88.0 ±36.5) min,术中平均出血量(150.0±70.5) ml.一次性结石清除率为89.7％(61/68),残留结石7例,其中4例二期手术取尽结石,3例行ESWL治疗.术后严重出血3例,行输血治疗;高热2例,予敏感抗生素治疗后痊愈.无胸膜、结肠等腹腔脏器损伤等并发症发生. 结论 斜仰截石位行PCNL术治疗肾输尿管结石安全有效,患者耐受性好.

Application of Anterolateral Supine Lithotomy Position in Percutaneous Nephrolithotomy

Objective To investigate the clinical value of percutaneous nephrolithotomy(PCNL) in anterolateral supine lithotomy position.Methods A total of 68 patients were treated by PCNL with anterolateral supine lithotomy position,including 28 of renal calculi and 40 of upper ureteric calculi.The maximum diameter of stone was(2.1±1.6) cm averagely.Results All patients were carried out the PCNL without conversion to open surgery.Among them,single channel was in 64 cases and dual-channel was in 4 cases.The operation time was(88.0±36.5) minute and the intraoperative blood loss was(150.0±70.5)ml.The one-time stone clearance rate was 89.7%.Residual stones were found in 7 cases and cleared by second operation in 4 cases and ESWL in 3 cases.Postoperative hemorrhage occurred in 3 cases and received blood transfusion,and hyperpyrexia in 2 cases and cured by antibiotic medicine.No complication such as visceral injury occurred.Conclusion PCNL is safe and effective for renal and ureteric calculi in the anterolateral supine lithotomy position with good tolerance of patient.