Service d'Urologie CHU Henri Mondor, Créteil, France.
Eur Urol. 2012 Jan;61(1):164-70. doi: 10.1016/j.eururo.2011.04.031. Epub 2011 Apr 29.
Percutaneous nephrolithotomy (PCNL) is the standard treatment for kidney stones >2cm. Recently, a novel approach in the modified supine lithotomy position has been developed.
To demonstrate with a video our technique of supine PCNL (sPCNL) and present our experience.
DESIGN, SETTING, AND PARTICIPANTS: From September 2009 to August 2010, 47 consecutive patients were prospectively evaluated. There were 31 single, 9 multiple, and 7 staghorn stones. The mean body mass index was 26.1±5 (range: 17.3-45.7), the mean stone size was 29.6±15.3mm (range: 10-75), and patients' American Society of Anesthesiologists scores were 1, 2, and 3 in 31, 11, and 5 cases, respectively.
Patients were positioned in Galdakao-modified supine Valdivia position. The details of the technique are shown in the film.
Success was defined as patients free of stones or with residual stone fragments <4mm.
Average operative room occupation time was 123.5±51.2min (range: 50-245). In the single, multiple, and staghorn stone groups, the immediate success rate after sPCNL was 90%, 78%, and 43%, respectively. Complications included one fever, two incidents of pyelonephritis, one renal colic, two urinary fistulae, one postoperative hemorrhage, and one incident of acute urinary retention. Mean hospital stay was 3.4±1.9 d (range: 2-12). Nine patients (19%) had a secondary procedure (extracorporeal shock wave lithotripsy or flexible ureterorenoscopy). At 3 mo, the success rate was 97%, 100%, and 100% in the single, multiple, and staghorn stone groups, respectively. However, the limitation of this study is its design, which is descriptive rather than comparative.
sPCNL is a safe and reproducible method. It offers the advantage of simultaneous retrograde and antegrade endoscopic combined intrarenal surgery, and we believe it is a further advancement in stone management. In addition, it is easier from the anesthetist point of view than the traditional prone approach. In our hands, it meant a simplification of the operative technique, resulting in a more time-efficient procedure.
经皮肾镜碎石术（PCNL）是治疗>2cm 肾结石的标准治疗方法。最近，一种改良仰卧截石位的新方法已经开发出来。
通过视频展示我们的仰卧 PCNL（sPCNL）技术并介绍我们的经验。
设计、设置和参与者：从 2009 年 9 月至 2010 年 8 月，前瞻性评估了 47 例连续患者。其中 31 例为单发结石，9 例为多发结石，7 例为鹿角形结石。平均体重指数为 26.1±5（范围：17.3-45.7），平均结石大小为 29.6±15.3mm（范围：10-75），患者的美国麻醉师协会评分分别为 31 例 1 分、11 例 2 分和 5 例 3 分。
患者置于改良仰卧瓦尔迪维亚体位。技术细节见影片。
成功定义为患者无结石或残留结石碎片<4mm。
平均手术室占用时间为 123.5±51.2min（范围：50-245）。在单发、多发和鹿角形结石组中，sPCNL 后的即刻成功率分别为 90%、78%和 43%。并发症包括发热 1 例、肾盂肾炎 2 例、肾绞痛 1 例、尿瘘 2 例、术后出血 1 例、急性尿潴留 1 例。平均住院时间为 3.4±1.9d（范围：2-12）。9 例（19%）接受了二次手术（体外冲击波碎石术或软性输尿管镜碎石术）。3 个月时，单发、多发和鹿角形结石组的成功率分别为 97%、100%和 100%。然而，本研究的局限性在于其设计，它是描述性的，而不是比较性的。
sPCNL 是一种安全且可重复的方法。它具有同时进行逆行和顺行内镜联合肾内手术的优势，我们认为这是结石处理的进一步进展。此外，从麻醉师的角度来看，它比传统的俯卧位方法更容易。在我们手中，这意味着手术技术的简化，从而使手术过程更高效。
