Al-Dessoukey Ahmad Aref, Moussa Ayman Salah, Abdelbary Ahmed Mahmoud, Zayed Ahmed, Abdallah Rabie, Elderwy Ahmad A, Massoud Amr Medhat, Aly Aly Hussein
1 Department of Urology, Faculty of Medicine, Beni Suef University , Beni Suef, Egypt .
J Endourol. 2014 Sep;28(9):1058-63. doi: 10.1089/end.2014.0078. Epub 2014 Jul 1.
To compare the safety, efficacy, and complications of percutaneous nephrolithotomy (PCNL) in the oblique supine lithotomy position vs the prone position in a randomized comparative study.
The study included 101 and 102 patients in the oblique supine lithotomy position and prone position, respectively. Inclusion criteria were renal and upper ureteral stones. Exclusion criteria were uncorrectable bleeding disorders, active urinary tract infection, and pregnancy.
Both the groups were comparable regarding the male/female ratio, stone size, and site. No significant differences were found in terms of the stone-free rate, blood transfusion rate, and complication rates. Significant differences were reported in mean hemoglobin loss (-1.03 and -2.18 g/dL), mean operative time (86.16 and 111.7 minutes), and mean hospital stay (49.88 and 81.2 hours) in the supine and prone positions, respectively, and anesthesiological parameters (the mean blood pressure decreased by 2 and 14.06 mm Hg, the mean heart rate changed by -0.82 and +13.28 beat/minute, and the peak air way pressure changed by +1.08 cm H2O and +7.56 cm H2O in the supine and prone positions, respectively).
PCNL in both positions was equally successful with no significant differences in complications. PCNL in the oblique supine lithotomy position was superior to PCNL in the prone position regarding operative time, hospital stay, and effects on respiratory and cardiovascular status, making it more comfortable for patients and anesthesiologists. Morbidly obese patients, patients with cardiologic disorders, and patients with pulmonary obstructive airway disease need further studies to show if they would benefit from these differences. Additionally, it is more comfortable for the surgeon with little challenges added in the initial puncture.
在一项随机对照研究中，比较斜仰卧截石位与俯卧位经皮肾镜取石术（PCNL）的安全性、有效性及并发症。
该研究分别纳入了101例处于斜仰卧截石位和102例处于俯卧位的患者。纳入标准为肾及上段输尿管结石。排除标准为无法纠正的出血性疾病、活动性尿路感染及妊娠。
两组在男女比例、结石大小及部位方面具有可比性。在结石清除率、输血率及并发症发生率方面未发现显著差异。仰卧位和俯卧位在平均血红蛋白丢失量（分别为-1.03和-2.18 g/dL）、平均手术时间（分别为86.16和111.7分钟）、平均住院时间（分别为49.88和81.2小时）以及麻醉学参数（仰卧位和俯卧位平均血压分别下降2和14.06 mmHg，平均心率分别变化-0.82和+13.28次/分钟，气道峰压分别变化+1.08 cmH₂O和+7.56 cmH₂O）方面均报告存在显著差异。
两种体位的PCNL均同样成功，并发症无显著差异。斜仰卧截石位的PCNL在手术时间、住院时间以及对呼吸和心血管状态的影响方面优于俯卧位的PCNL，这使其对患者和麻醉医生而言更为舒适。病态肥胖患者、患有心脏疾病的患者以及患有慢性阻塞性肺疾病的患者是否会从这些差异中获益，还需要进一步研究。此外，对于外科医生而言，这种体位在初始穿刺时增加的挑战较小，更为舒适。
