斜卧体位与俯卧体位在微创经皮肾镜取石手术中的比较

目的: 比较斜卧位、俯卧位在微创经皮肾镜取石术中应用的安全性和疗效。方法: 2组上尿路结石患者共62例, 其中斜卧位27例, 俯卧位35例, 术前2组患者在年龄、性别、合并症等方面比较,差异均无统计学意义(P>0.05),记录手术时间、出血量、围手术期并发症及术后住院天数等,并进行统计学分析。结果: 2组共62例手术均获成功,无穿刺失败和中转开放手术者。斜卧位组手术时间(85.1±25.3) min;术中出血量为(117.5±49.7) mL;未发生严重的并发症。俯卧位组手术时间为(97.2±30.6) min;术中出血量为(149.3±53.1) mL;术中发现气胸1例,术后发生大出血2例。2组病人在术中出血量、手术并发症及术后住院天数等方面比较,差异均有统计学意义(P<0.05)。结论: 改良斜卧位经皮肾镜取石术疗效与俯卧位相似, 但改良斜卧位手术患者较易耐受,且并发症少,安全性高,在临床上有良好的推广前景。

Comparison the effects of prone and modified recumbent positions on minimal invasive percutaneous nephrolithotomy

Objective:To compare the safety and efficacy of prone and modified recumbent positions on minimal invasive percutaneous nephrolithotomy.Methods:A total of 62 patients with upper urinary calculi were grouped into two groups,one of which consisted of 27 patients who underwent the minimal invasive percutaneous nephrolithotomy with modified recumbent position,and the other 35 patients with prone position.There was no significant statistical difference in the age,gender and complications between the two groups before surgery(P>0.05).Duration of and blood loss during surgery,complications in the perioperative period,and the length of postoperative hospital stay were all recorded.The data were analyzed by SPSS 13.0.Results:Surgery was successful in all cases.There was no failure to puncture nor need to resort to open surgery.Average operation duration for the modified recumbent position group was(85.1± 25.3) min vs(97.2±30.6) min for the prone position group.Mean blood loss during the operation was(117.5± 49.7) mL vs(149.3±53.1) mL.There were no severe complications during and after surgery in the modified recumbent position group.In the prone position group,s one patient suffered pneumothorax during the operation and two suffered selective renal artery embolization because of massive hemorrhaging following the operation.There were significant differences in blood loss during surgery,in complications during the perioperative period,and in length of postoperative stay in hospital(P<0.05) between the two groups.Conclusion:The patients are safer and more easily tolerate the minimal invasive percutaneous nephrolithotomy in the modified recumbent position than in the prone position,though the treatment efficacy of these two kinds of operation is similar.It is recommended that the modified recumbent position should be used generally in the percutaneous nephrolithotomy.