改良侧卧位微通道经皮肾镜取石术治疗高危上尿路结石的临床价值*

Modified lateral position for mini-percutaneous nephrolithotomy in high-risk patients with upper urinary tract stones*

摘要:

目的 通过对比研究改良侧卧位与俯卧位微通道经皮肾镜取石术（Mini-PCNL）在治疗高危上尿路结石中的安全性和疗效，探讨改良侧卧位的临床价值。方法 回顾性分析2010年6月-2015年12月该科82例高危上尿路结石患者超声引导下Mini-PCNL术的临床资料，其中采取改良侧卧位组43例，俯卧位组39例。分析两组患者的手术时间、结石清除率、住院时间、术后血红蛋白下降值和并发症。结果 术前改良侧卧位组与俯卧位组在性别、年龄、结石类型、体质指数（BMI）、美国麻醉师协会评分（ASA）和术前的合并症方面差异均无统计学意义（P >0.05）；改良侧卧位组建立通道时间为（7.88±0.82）min，而俯卧位组为（8.50±0.80）min，P <0.01；改良侧卧位组总结石清除率为95.35%，而俯卧位组为74.36%，P <0.01，术后血红蛋白下降值分别为（9.33±2.49）和（10.90±3.54）g/L，P <0.05；两组的胸膜损伤率差异有统计学意义（P <0.05），两组患者住院时间和一期手术时间差异无统计学意义（P >0.05）。结论 改良侧卧位Mini-PCNL术治疗高危上尿路结石具有建立通道时间短、结石清除率高、胸膜损伤少、出血量少、耐受性好和安全性高等优势，值得临床推广使用。

Abstract:

Objective To compare the safety and efficacy of minimally-access percutaneous nephrolithotomy (Mini-PCNL) in modified lateral position and prone position in high-risk patients with upper urinary tract stones and explore the clinical value of the modified lateral position. Methods We retrospectively analyzed 82 cases of high-risk patients underwent ultrasound-guided percutaneous nephrolithotomy from June 2010 to December 2015. 43 cases in group of modified lateral position and 39 case in group of prone position. The mean operating time, the success rate of stone fragmentation, hospitalization days, the value of postoperative hemoglobin decline and complication rate of patients were record and compared 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, BMI, the score of ASA and preoperative complication. There was statistical significance in found access time, (7.88 ± 0.82) min in the modified lateral position group and (8.50 ± 0.80) min in the prone position group (P < 0.01). The stone free rate in the modified lateral position group (95.35 %) was higher than that in prone position group (74.36 %), the value of postoperative hemoglobin decline were (9.33 ± 2.49) g/L and (10.90 ± 3.54) g/L, respectively (P < 0.05); Two groups of the pleural damage rate had significant difference (P < 0.05); the hospitalization days and operating time were no statistical difference between the two groups (P > 0.05). Conclusions The Mini-PCNL in modified lateral position for high-risk patients had advantages of found access time, stone clearance rate, pleural injury, blood loss, comfort degree and security and worthy of clinical promoting.