Department of Urology, Casey Hospital, Berwick, Victoria, Australia.
J Endourol. 2013 Jun;27(6):705-9. doi: 10.1089/end.2012.0650. Epub 2013 Mar 18.
The recently described Galdakao-modified supine Valdivia position for percutaneous nephrolithotomy (PCNL) has become increasingly popular. We have made further modifications to this and describe our recent experience compared with our previous prone cases.
From April 2011, all patients undergoing PCNL have been placed in the modified supine position. A suction beanbag is used to secure the patient and improve renal access. Data on patient age, comorbidities, stone size, operative time, radiation exposure, complications, stone clearance, and length of stay was collected, analyzed, and compared with data from our previous year's prone surgery.
Thirty-six patients in each group underwent 41 PCNLs. The groups were well matched for age, sex, and comorbidity. The supine patients tended to have a higher body mass index. Stones in the supine group were larger (32.6 vs 25.7 mm, P=0.0402), and the operative time was shorter (86.2 vs 116.6 min, P=0.003). Radiation time was similar in the two groups, but the dose was higher in the supine group. Stone clearance rates, length of stay (2.5 days), and complications were similar. Nineteen (46%) patients underwent simultaneous lower urinary tract procedures including 4 (10%) with complete staghorn calculi for which ureterorenoscopy was used to fragment ureteral and upper renal pole stones.
The modified supine position for PCNL has a number of advantages for the patient and staff compared with the prone position. Despite a more obese study group with larger stones, we have maintained stone clearance rates and significantly reduced operative time with no increase in complications. The technique has been easy to learn and teach. A major advantage has been simultaneous access to the lower urinary tract for ureteroscopy and stent placement, and this has helped with complete stone clearance.
最近描述的改良仰卧位加迪斯瓦利维亚位（Galdakao-modified supine Valdivia position）经皮肾镜碎石术（PCNL）已越来越受欢迎。我们对该体位进行了进一步改良，并将其与我们之前的俯卧位病例进行了比较。
自 2011 年 4 月以来，所有接受 PCNL 的患者均被置于改良仰卧位。使用吸引豆袋固定患者，以改善肾脏通道。收集并分析了患者年龄、合并症、结石大小、手术时间、辐射暴露、并发症、结石清除率和住院时间的数据，并与前一年的俯卧位手术数据进行了比较。
每组各 36 例患者接受了 41 例 PCNL。两组在年龄、性别和合并症方面匹配良好。仰卧位患者的体重指数更高。仰卧位组的结石更大（32.6 与 25.7mm，P=0.0402），手术时间更短（86.2 与 116.6min，P=0.003）。两组的辐射时间相似，但仰卧位组的辐射剂量更高。结石清除率、住院时间（2.5 天）和并发症相似。19 例（46%）患者同时进行了下尿路手术，其中 4 例（10%）为完全鹿角形结石，采用输尿管镜碎石术处理输尿管和上肾极结石。
与俯卧位相比，改良仰卧位 PCNL 对患者和医务人员有许多优势。尽管研究组患者更肥胖，结石更大，但我们仍保持了结石清除率，并显著缩短了手术时间，同时并发症没有增加。该技术易于学习和教授。一个主要的优势是同时可以进入下尿路进行输尿管镜检查和支架置入，这有助于实现完全结石清除。
