肾鹿角形结石截石斜仰卧位及俯卧位下经皮肾镜碎石取石术的研究  

Comparative study on percutaneous nephrolithotomy for staghorn renal calculi in the oblique supine lithotomy position and prone position

作　　者：姜刚刚 曾鹏[2] 蓝子权 杨江根 黄桂晓 江先汉[3] Jiang Ganggang;Zeng Peng;Lan Ziquan;Yang Jianggen;Huang Guixiao;Jiang Xianhan(Department of Urology,Shenzhen Luohu People's Hospital,Shenzhen Luohu Hospital Group,Shenzhen 518000,China;Department of Urology,The Sixth Affiliated Hospital of Guangzhou Medical University,Qingyuan People's Hospital,Qingyuan 511500,China;Department of Urology,The Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]深圳市罗湖医院集团罗湖区人民医院泌尿外科,深圳518000 [2]广州医科大学附属第六医院清远市人民医院泌尿外科,清远511500 [3]广州医科大学附属第五医院泌尿外科,广州510000

出　　处：《国际医药卫生导报》2022年第12期1684-1688,共5页International Medicine and Health Guidance News

基　　金：深圳市罗湖区软科学研究计划项目(LX20201004)。

摘　　要：目的探讨比较肾鹿角形结石截石斜仰卧位及俯卧位下经皮肾镜碎石取石术的治疗效果。方法回顾性分析2012年1月至2020年4月肾鹿角形结石患者180例,均用经皮肾镜碎石术治疗,广州医科大学附属第五医院100例(A组)和广州医科大学附属第六医院80例(B组)。A组男43例、女57例,年龄(53.42±10.71)岁,采取俯卧位;B组男34例、女46例,年龄(52.83±11.25)岁,采取截石斜仰卧位。观察并比较两组患者穿刺部位、手术时间、术中出血量、Ⅰ期结石清除率、住院日、血流动力学(收缩压、舒张压及心率)改变。计量资料采用t检验,计数资料采用χ^(2)检验。结果两组穿刺部位和Ⅰ期结石清除比较,差异均无统计学意义(均P>0.05);B组手术时间、住院日分别为(90.13±17.70)min、(10.15±1.54)d,均低于A组(107.25±45.55)min、(14.92±5.23)d,差异均有统计学意义(均P<0.05)。B组术后严重并发症发生率为0.00%(0/80),低于A组6.00%(6/100),差异有统计学意义(P<0.05)。麻醉前30 min(T_(0))、麻醉成功后(T_(1)),两组患者收缩压、舒张压、心率比较,差异均无统计学意义(均P>0.05);术中25 min(T_(2))、拔管时(T_(3)),B组收缩压分别为(132.00±13.50)mmHg(1 mmHg=0.133 kPa)、(128.97±11.84)mmHg,舒张压分别为(80.24±9.88)mmHg、(80.56±7.93)mmHg,均高于A组的(125.24±15.63)mmHg、(123.84±15.65)mmHg及(75.94±13.92)mmHg、(73.93±10.25)mmHg,差异均有统计学意义(均P<0.05);A组T_(0)、T_(1)时收缩压分别为(138.30±16.83)mmHg、(134.72±17.56)mmHg,舒张压分别为(84.00±13.00)mmHg、(81.23±12.84)mmHg,与T_(2)时(125.24±15.63)mmHg、(75.94±13.92)mmHg比较,差异均有统计学意义(均P<0.05);组内和组间心率比较,差异均无统计学意义(均P>0.05)。结论肾鹿角形结石患者经皮肾镜碎石术采用截石斜仰卧位和俯卧位的效果相当,但截石斜仰卧位较俯卧位能显著缩短手术时间和住院日,且手术更安全。Objective To explore the safety and efficacy of percutaneous nephrolithotomy(PCNL)for staghorn renal calculi in the oblique supine lithotomy position and prone position.Methods A retrospective analysis was performed on 180 patients with staghorn renal calculi from January 2012 to April 2020,all of whom were treated with PCNL,including 100 cases from The Fifth Affiliated Hospital of Guangzhou Medical University(group A)and 80 cases from The Sixth Affiliated Hospital of Guangzhou Medical University(group B).In group A,there were 43 males and 57 females,aged(53.42±10.71)years,undergoing surgery in the prone position;in group B,there were 34 males and 46 females,aged(52.83±11.25)years,undergoing surgery in the oblique supine lithotomy position.The puncture site,operative time,intraoperative bleeding volume,stageⅠstone-free rate,hospital stay,hemodynamic changes(systolic blood pressure,diastolic blood pressure,and heart rate)were observed and compared in the two groups.t test was used for the measurement data andχ^(2)test was used for the count data.Results There were no statistically significant differences in the puncture site and stageⅠstone-free rate between the two groups(both P>0.05).The operative time and hospital stay of group B were(90.13±17.70)min and(10.15±1.54)d,respectively,which were lower than those of group A[(107.25±45.55)min and(14.92±5.23)d],with statistically significant differences(both P<0.05).The incidence of postoperative serious complications in group B was 0.00%(0/80),which was lower than that in group A[6.00%(6/100)],with a statistically significant difference(P<0.05).There were no statistically significant differences in the systolic blood pressure,diastolic blood pressure,and heart rate between the two groups 30 min before anesthesia(T_(0))and after anesthesia(T_(1))(all P>0.05).The systolic blood pressure of group B was(132.00±13.50)mmHg(1 mmHg=0.133 kPa)at intraoperative 25th min(T_(2))and(128.97±11.84)mmHg at extubation(T_(3)),respectively,the diastolic blood pressures were

关 键 词：肾鹿角形结石 经皮肾镜碎石取石术 截石斜仰卧位 俯卧位 

分 类 号：R699.2[医药卫生—泌尿科学]