Xue Juan, Yang Jianfu, Jiang Zhiqiang, He Leye, Jiang Xianzhen, Dai Yingbo, Yin Guangming
Department of Urology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012 Apr;37(4):408-12. doi: 10.3969/j.issn.1672-7347.2012.04.016.
To compare the safety and efficacy of prone and modified recumbent positions on minimal invasive percutaneous nephrolithotomy.
A total of 62 patients with upper urinary calculi were grouped into two groups, one of which consisted of 27 patients who underwent the minimal invasive percutaneous nephrolithotomy with modified recumbent position, and the other 35 patients with prone position. There was no significant statistical difference in the age, gender and complications between the two groups before surgery (P>0.05). Duration of and blood loss during surgery, complications in the perioperative period, and the length of postoperative hospital stay were all recorded. The data were analyzed by SPSS 13.0.
Surgery was successful in all cases. There was no failure to puncture nor need to resort to open surgery. Average operation duration for the modified recumbent position group was (85.1± 25.3) min vs (97.2±30.6) min for the prone position group. Mean blood loss during the operation was (117.5± 49.7) mL vs (149.3±53.1) mL. There were no severe complications during and after surgery in the modified recumbent position group. In the prone position group, s one patient suffered pneumothorax during the operation and two suffered selective renal artery embolization because of massive hemorrhaging following the operation. There were significant differences in blood loss during surgery, in complications during the perioperative period, and in length of postoperative stay in hospital (P<0.05) between the two groups.
The patients are safer and more easily tolerate the minimal invasive percutaneous nephrolithotomy in the modified recumbent position than in the prone position, though the treatment efficacy of these two kinds of operation is similar. It is recommended that the modified recumbent position should be used generally in the percutaneous nephrolithotomy.
比较俯卧位与改良仰卧位在微创经皮肾镜取石术中的安全性和有效性。
将62例上尿路结石患者分为两组，其中27例行改良仰卧位微创经皮肾镜取石术，另外35例行俯卧位手术。两组患者术前年龄、性别及并发症方面差异无统计学意义（P>0.05）。记录手术时间、术中出血量、围手术期并发症及术后住院时间。数据采用SPSS 13.0软件进行分析。
所有手术均成功，无穿刺失败及转为开放手术的情况。改良仰卧位组平均手术时间为（85.1±25.3）分钟，俯卧位组为（97.2±30.6）分钟。术中平均出血量改良仰卧位组为（117.5±49.7）毫升，俯卧位组为（149.3±53.1）毫升。改良仰卧位组术中及术后无严重并发症。俯卧位组1例患者术中发生气胸，2例患者术后因大出血行选择性肾动脉栓塞术。两组术中出血量、围手术期并发症及术后住院时间差异有统计学意义（P<0.05）。
改良仰卧位在微创经皮肾镜取石术中较俯卧位更安全，患者耐受性更好，虽然两种手术方式的治疗效果相似。建议在经皮肾镜取石术中普遍采用改良仰卧位。
