斜卧-截石位和俯卧位经皮肾镜碎石术治疗巨大肾结石的疗效比较  

Comparison of the effects on percutaneous nephrolithotomy for huge renal calculus in prone and semisupine-lithotomy position

作　　者：谢宗兵 周仁实 陈忠冼 黄海[2] 

机构地区：[1]阳春市人民医院泌尿外科,广东阳春529500 [2]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《岭南现代临床外科》2013年第3期192-194,共3页Lingnan Modern Clinics in Surgery

基　　金：国家自然科学基金项目(青年81101947);广东省自然科学基金(10151008901000070);广东省科技社会发展项目(2012B032000006);广东省医学科研基金(A2008178);国家大学生创新实验计划项目(No.38);阳江市科技项目卫(2011)32

摘　　要：目的对比斜卧-截石位与俯卧位经皮肾镜碎石术治疗巨大肾结石的临床疗效。方法对2011年3月～2013年3月在阳春市人民医院施行斜卧-截石位(A组)和俯卧位(B组)经皮肾镜碎石术治疗巨大肾结石的84例患者临床资料进行回顾性分析,比较两组的手术时间、术中出血量、并发症和一期结石取净率等资料。结果 84例手术均获成功,无中转开放手术。斜卧-截石位组采用单通道47例,采用双通道1例。俯卧位组36例均采用单通道。手术时间俯卧位组(B组)(168.2±31.4)min,斜卧-截石位组(126.4±26.4)min,较俯卧位组缩短;出血量俯卧位组(B组)(140.3±52.2)mL,斜卧-截石位组(130.8±55.1)mL;一期结石取净率斜卧-截石位组88.3%,俯卧位组81.2%;俯卧位组术后1例出现继发岀血,经保守治疗后好转;两组术中均无严重并发症发生。结论斜卧-截石位与俯卧位施行PCNL治疗肾结石的效果相似,但前者在手术时间上明显较后者短,尤其适合合并有输尿管结石患者,并且使患者术中较为舒适,便于术中麻醉观察和术中碎石冲出体外。Objective To evaluate the clinical effect of percutaneous ephrolithotomy （PCNL） for huge renal calculus in different position ： prone and semisupine-lithotomy position. Methods From March 2011 to March 2013,.a total of 84 patients with huge renal calculus underwent PCNL in different position： semisupine-lithotomy position （A group） and prone position （B）. Operation time, blood loss, primary stone clearanceand complications were recorded and compared between two groups. Results PCNL was successfully completed in all the patients ,.no one converted to open surgery. Single-tract PCNL was performed for 47 cases in semisupine-lithotomy groups , two tracts 1 case. The all patients in prone position group were treated with single-tract PCNL. .The mean operation time in group A was less than that in group B..The stone free rate was 88.3% and 81.2% in semisupine-lithotomy group and prone position group respectively..One case appeared secondary bleeding in prone position group who was cured by conservative treatment..There were no severe complications occurred in both groups..Conclusion PCNL in semisupine-lithotomy position is an effective alternative for treating renal calculus..The semisupine-lithotomy position allows easier irrigation of stone fragments. .It is more comfortable for the patient during operation and facilitates monitoring of anesthesia.

关 键 词：经皮肾镜碎石术 斜卧-截石位 俯卧位 巨大肾结石 

分 类 号：R692.4[医药卫生—泌尿科学]