改良侧卧位经上盏路径行微通道经皮肾镜取石术的临床应用  

The clinical application of the superior calix access mini-Percutaneous nephrolithotomy by the modified lateral position

作　　者：符浩[1] 陈选才 宋汶珂[2] 段斌[1] 唐亚纯[1] 

机构地区：[1]南华大学附属南华医院泌尿外科,湖南衡阳421002 [2]南华大学附属南华医院妇产科

出　　处：《中南医学科学杂志》2017年第3期271-275,共5页Medical Science Journal of Central South China

基　　金：2014年度湖南省教育厅基金(编号14C0993)

摘　　要：目的对比观察改良侧卧位与俯卧位经上盏入路行微通道经皮肾镜取石术在治疗上尿路结石中的安全性和疗效,探讨改良侧卧位经上盏入路的优势和应用前景。方法收集本科98例患者超声引导下经上盏路径行MiniPCNL术的临床资料,分为改良侧卧位组和俯卧位组,其中改良侧卧组52例,俯卧位组46例。分析两组患者的手术时间、结石清除率、住院时间、术后血色素下降值和并发症。结果术前改良侧卧位组与俯卧位组在性别、年龄、结石类型、术前的合并症方面均无统计学意义(P>0.05)。改良侧卧位组手术时间为(52.89±7.57)min短于俯卧位组(66.54±11.44)min,差异有显著性P<0.01;改良侧卧位组结石总清除率96.15%高于俯卧位组76.09%(P<0.01);术后血红色素平均下降幅度分别为(9.73±7.60)g/L和(16.20±10.03)g/L,P<0.01;两组的胸膜损伤率间差异有显著性(P<0.05),但两组患者住院时间比较,差异无显著性。结论改良侧卧位经上盏路径行经皮肾镜取石术具有手术时间短、结石清除率高、胸膜损伤少、出血量少、患者易耐受等优势,安全性高,值得临床推广使用。Objective To compare the safety and efficacy of Minimally-access Percutaneous Nephrolithotomy（ MiniPCNL） through the superior calix access in the modified lateral position and prone position,and explore the advantage and application prospect of the modified lateral position. Methods From June 2013 to December 2015,98 cases of the Mini-PCNL guided by ultrasound through the upper-pole access were divided into two groups（ group of the modified lateral position with 52 cases and group of prone position with 46 cases）.The mean operating time,the success rate of stone fragmentation,hospitalization days,the value of postoperative hemoglobin decline and complication rate of patients were recorded between the two groups. Results There was no statistical significance between the modified lateral position group and prone position group（ P〉0.05） in gender,age,stone type and preoperative complication. There was statistical significance in operative time,（ 52.89± 7.57） min in the modified lateral position group and（ 66.54±11.44） min in the prone position group（ P〈0.01）.The stone free rate in the modified lateral position group（ 96.15%） was higher than that in the prone position group（ 76.09%）,the value of postoperative hemoglobin decline were（ 9.73±7.60） g/L and（ 16.20±10.03） g/L,respectively（ P〈0. 01）; Two groups of the pleural damage rate had significant difference（ P〈0.05）; the hospitalization days had no statistical difference betwen the two groups. Conclusions The Mini-PCNL through the the superior calix by the modified lateral position had the advantages in operative time,stone clearance rate,pleural injury,blood loss,comfort degree and security.It is worthy of clinical application.

关 键 词：改良侧卧位 经皮肾取石术 上盏路径 临床应用 

分 类 号：R693.4[医药卫生—泌尿科学]