侧卧位微创经皮肾镜碎石术治疗肾结石的临床应用价值  

Clinical value of lateral decubitus position for minimally invasive percutaneous nephrolithotomy

作　　者：梁坚[1] 李文雄[1] 李峻[1] 罗力[1] 王森[1] 王忠[1] 曹明欣[1] 

机构地区：[1]广东药学院第一附属医院泌尿外科,广州510080

出　　处：《临床泌尿外科杂志》2008年第6期443-445,共3页Journal of Clinical Urology

摘　　要：目的：探讨侧卧位在微创经皮肾镜手术中的临床应用价值。方法：回顾性分析2007年1-12月采用侧卧位微创经皮肾镜手术治疗肾结石患者56例的临床资料：单侧结石48例，双侧结石8例。肾单发结石38例，肾鹿角形结石18例。结石最大经2．4-6．7cm。结果：平均手术时间85min，平均住院12天。45例次单发肾结石手术中，38例次行单通道一期手术；7例次因术中发现肾积脓，留置造瘘管后改二期手术；19例次肾鹿角形结石均采用双通道取石，其中一期手术取石8例次，二期手术取石11例次。术前血红蛋白112±28g／L，一期手术后1-3天检查血红蛋白为102.5±31.5g／L。术后需用ESWL辅助治疗17例。总结石排净率为92.3％。结论：侧卧位是泌尿外科医生最熟悉的手术体位，也是进行微创经皮肾镜手术的理想手术体位，特别是B超定位穿刺技术的广泛应用，更应该推广使用侧卧位进行微创经皮肾镜手术。Objective：To explore the clinical value of lateral decubitus position for minimally invasive percuta-neous nephrolithotomy（mPCNL）. Methods：64 renal units（56 patients） with renal calculi treated with mPCNL in lateral decubitus position from Jan 2007 to Dec 2007 were retrospectively reviewed. Among the 56 patients（64 renal units）reviewed, 48 cases suffered from unilateral renal calculi,8 cases bilateral. 38 cases＇（45 renal units＇） calculi were single and 18 cases＇（19 units＇） were staghorn. The stone measured by KUB ranged 2.4 to 6.7 cm. Resuits：Mean operative time was 85 min（ranged 45-180 min） and mean time of hospital stay was 12 days（8-21 days）. Among 45 units with single calculus,38 units were treated with only one percutaneous access tract in a single session and 7 units underwent a second-look procedure because of pyonephrosis. All 19 units with staghorn calculi were treated with 2 tracts. Among them, 8 units were treated in a single session and 11 required a secondary-look procedure. The mean preoperative hemoglobin was 112±28 g/L. On the 1-3 postoperative day, hemoglobin was reexamined, with a mean of 102.5±31.5 g/L. Postoperatively, ESWL was used to treat residual stones in 17 cases. The total calculi clearance rate was 92.3%. Conclusions：The lateral decubitus position ,the most familiar to urologists,is also an ideal position for mPCNl. With the wide use of the puncture guided By B ultrasonics,the lateral decubitus positon would be acceped widely.

关 键 词：肾结石 经皮肾穿刺取石术 侧卧位 

分 类 号：R692.4[医药卫生—泌尿科学]