改良 Valdivia 体位和俯卧位经皮肾镜取石术治疗肾结石的疗效和安全性比较  

Comparison on efficacy and safety of percutaneous nephrolithotomy for the treatment of renal stones：modified supine Valdivia versus prone position

作　　者：周水根[1] 王玲[1] 徐晓峰[1] 王龙信[1] 董杰[1] 周凯[1] 张征宇[1] 

机构地区：[1]南京军区南京总医院泌尿外科,210002

出　　处：《中华泌尿外科杂志》2015年第6期405-408,共4页Chinese Journal of Urology

摘　　要：目的：比较改良Valdivia体位和传统俯卧位经皮肾镜取石术（ PCNL）的疗效及安全性。方法回顾性分析2012年12月至2014年9月80例接受PCNL治疗肾结石患者的临床资料。根据手术体位，将患者分为两组：改良Valdivia体位组44例，俯卧位组36例。两组年龄、性别、麻醉分级、结石直径[（27．7±4．3）和（28．3±3．9） mm]等比较差异均无统计学意义（P＞0．05）。对两组总手术时间、多通道使用率、失血量、并发症发生率及结石清除率等进行比较。结果80例手术均穿刺成功，无中转开放，无结肠损伤、胸膜腹膜穿孔、死亡等严重并发症。俯卧位组有1例因结石体积较大、手术时间过长（130 min），患者气道内压过高而中止手术，1周后行二期PCNL。改良Valdivia体位组总手术时间为（67．7±24．5） min，短于俯卧位组的（91．5±29．8） min，差异有统计学意义（P＜0．05）。两组多通道使用率[14％（6／44）和22％（8／36）]、血红蛋白下降值[（1．3±0．2）和（1．4±0．7） g／L]、并发症发生率[18％（8／44）和19％（7／36）]及结石清除率[80％（35／44）和86％（31／36）]比较差异均无统计学意义（ P＞0．05）。结论改良Valdivia和俯卧位PCNL治疗肾结石均安全、有效，前者总手术时间较短。Objective To compare the efficacy and safety of percutaneous nephrolithotomy （ PCNL） in modified supine Valdivia and traditional prone positions for the treatment of renal stones.Methods Clinical data of 80 consecutive patients with renal calculi who accepted PCNL from December 2012 to September 2014 were retrospectively reviewed.They were divided into modified supine Valdivia group （ n=44） and prone position group （n=36） according to the position during surgery.There was no significant difference between the 2 groups in age, sex, ASA class, stone location and size （P〉0.05）.Total operative time, ratio of multi-access, blood loss, perioperative complications and stone-free rate were compared between the 2 groups.Results All punctures were performed successfully.No case was converted to open surgery.No severe complications such as colon injury, pleura or peritoneum perforation, or death occurred intra-and post-operatively.In prone position, 1 patient was found to develop high intra-trachea pressure because of large stone burden and prolonged operative time （130 min）.This procedure was stopped and the patient received the second session of PCNL 1 week later.The mean total operative time was significantly shorter in the modified supine than in the prone position （ 67.7 ±24.5 min versus 91.5 ±29.8 min, P〈0.05）.There were no significant differences in ratio of multi-access （14% versus 22%）, mean blood loss （1.3 ±0.2 g/L versus 1.4 ±0.7 g/L）, incidence of complications （18% versus 19%）, and stone clearance rate （ 80% versus 86%） between the 2 groups （ P 〉0.05 ） .Conclusion PCNL in modified supine Valdivia is as safe and effective as that of prone position for the treatment of renal stones, but the former is more time-saving than the latter.

关 键 词：肾造口术 经皮 仰卧位 俯卧位 回顾性研究 

分 类 号：R699.2[医药卫生—泌尿科学]