Rana Abdul Majid, Bhojwani Jai Parkash, Junejo Noor Nabi, Das Bhagia Sanmukh
Kidney Centre Postgraduate Training Institute, Karachi, Pakistan.
Urology. 2008 Apr;71(4):581-5. doi: 10.1016/j.urology.2007.10.059. Epub 2008 Feb 15.
Percutaneous nephrolithotomy (PCNL) has historically been performed with the patient in the prone position, which has inherent drawbacks. Supine PCNL has numerous benefits in terms of safety, efficacy, and versatility and is comparable with respect to vascular and bowel injury. This study was intended to prove that PCNL with the patient in the supine position is an alternative method of doing PCNL along with comprehensive technique.
A total of 184 patients with 191 renal units underwent tubeless supine PCNL from 2005 to May 2007. Their mean age was 32 years and mean weight 62 kg. After insertion of a retrograde 5F ureteral catheter, the patient was placed in the supine position with a small towel roll under the ipsilateral flank, raising it by 20 degrees. Caliceal entry was achieved with an 18-gauge spinal needle, and the tract was dilated up to 27F with Alkans dilators over a 0.032-in. guidewire using fluoroscope only, with the patient under general anesthesia.
Primary stone clearance was achieved in 84% patients. Of the 184 patients, 94% had a single and 6% had a double tract; 72% of patients had a lower, 25% a middle, and 3% an upper caliceal puncture. The mean single stone size was 3.5 cm, and the mean multiple stone burden was 12 cm. No vascular or splanchnic injury or bowel transgression was observed. Tubeless PCNL was possible in 87% patients; 4% patients required transfusion, and 1 patient each had a perinephric collection and a plural effusion.
Tubeless PCNL with the patient in the supine position is an independent method of treating renal stones without complementing PCNL in the prone position. It adds ease and comfort to the patient, anesthesiologist, and surgeon.
经皮肾镜取石术（PCNL）传统上是在患者俯卧位下进行的，存在一些固有缺点。仰卧位PCNL在安全性、有效性和多功能性方面有诸多益处，在血管和肠道损伤方面相当。本研究旨在证明患者仰卧位的PCNL是一种与综合技术相结合的替代PCNL的方法。
2005年至2007年5月，共有184例患者的191个肾单位接受了无管仰卧位PCNL。他们的平均年龄为32岁，平均体重62千克。插入逆行5F输尿管导管后，患者仰卧，患侧腰部下方垫一小毛巾卷，抬高20度。用18号脊麻针进入肾盏，在仅使用荧光镜的情况下，在全身麻醉的患者中，通过0.032英寸导丝用Alkans扩张器将通道扩张至27F。
84%的患者实现了一期结石清除。184例患者中，94%为单通道，6%为双通道；72%的患者为下盏穿刺，25%为中盏穿刺，3%为上盏穿刺。平均单结石大小为3.5厘米，平均多发结石负荷为12厘米。未观察到血管或内脏损伤或肠道穿孔。87%的患者可行无管PCNL；4%的患者需要输血，各有1例患者出现肾周积液和胸腔积液。
患者仰卧位的无管PCNL是一种独立的治疗肾结石的方法，无需补充俯卧位PCNL。它为患者、麻醉医生和外科医生增加了便利性和舒适度。
