患侧腰部抬高45°仰卧位经皮肾镜碎石术治疗肥胖及高危患者肾、输尿管上段结石(102例报告)  

Percutaneous Nephrolithotomy at Supine Position with 45° Lumbar Lifting for Renal and Upper Ureteral Stones in Obese or High-risk Patients: Report of 102 Cases

作　　者：侯飓[1] 耿秀霞 赵谦[1] 宋飞[1] 郭环宇[1] 黄伟[1] 韩增箎[1] 邵建国[1] 

机构地区：[1]山东中医药大学第二附属医院泌尿外科,济南250001 [2]河南省台前县疾病预防控制中心,台前457600

出　　处：《中国微创外科杂志》2013年第1期29-31,35,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨肥胖及高危患者患侧腰部抬高45°仰卧位经皮肾镜碎石清石术(percutaneous nephrolithotomy,PCNL)的临床价值。方法总结2004年7月～2011年9月我院102例肥胖及高危肾输尿管上段结石患者患侧腰部抬高45°仰卧位PCNL的临床资料,肥胖25例,BMI 24～34;高危77例,合并中重度肺部疾患、高血压病、糖尿病及慢性肾功能不全等。肾结石77例,长径2.2～5.5 cm;输尿管上段结石25例,长径1.5～2.6 cm。PCNL时联合应用气压弹道以及超声碎石。结果 102例均顺利完成手术,无中转开放,无胸膜损伤及周围脏器损伤等并发症。术后4～10天复查X线、B超或CT,结石清除率89.2%(91/102)。11例肾盂或肾盏残余结石,最大径1.1～1.8 cm,行ESWL碎石。结论患侧腰部抬高45°仰卧位PCNL对肥胖及高危肾输尿管上段结石患者安全、可行。Objective To investigate the value of percutaneous nephrolithotomy （PCNL） at a supine position with 45° lumbar lifting for obese or high-risk patients with renal or upper ureteral stones. Methods A retrospective analysis on 102 obese or high- risk patients with renal or upper ureteral stones, who underwent PCNL in our hospital from July 2004 to September 2011. During the procedure, all the patients were at a supine position with their waist being lifted by 45 °. Among the cases, 25 bad obesity （ BM1：24 - 34） , the other 77 were high-risk patients, who were complicated with severe pulmonary diseases, hypertension, diabetes, and chronic renal deficiency. Renal stones were detected in 77 of the patients （2.2 to 5.5 cm in diameter） , and upper ureteral stones were found in the other 25 patients （ 1.5 to 2.6 cm in diameter）. PCNL combined with pneumatic lithotripsy and ultrasonic lithotripsy were carried out in all the cases. Results The procedure was completed successfully in all the 102 patients without conversion to open surgery. None of the patients developed injuries to the pleura or other inner organs. Re-examination by X-ray, B-uhrasonography or CT in 4 to 10 days after the operation showed a clearance rate of 89.2% （91/102）. Residual stones were found in the renal pelvis or calices in 11 of the patients （ 1.1 to 1.8 cm in the maximum diameter） , and all of them received ESWL afterwards. Conclusion PCNL at supine position with 45° lumbar lifting is safe and feasible for obese or high-risk patients with renal or upper ureteral stones.

关 键 词：腰部抬高45°经皮肾镜碎石术 肥胖 高危 肾输尿管上段结石 

分 类 号：R699[医药卫生—泌尿科学]