Desoky Esam A E, Allam Mohammed N, Ammar Mostafa K, Abdelwahab Khaled M, Elsaid Diab A, Fawzi Amr M, Alayman Ahmed A, Shahin Ashraf M S, Kamel Hussein M
Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Arab J Urol. 2012 Jun;10(2):143-8. doi: 10.1016/j.aju.2011.12.008. Epub 2012 Mar 7.
Percutaneous nephrolithotomy (PCNL) is the standard management for large and/or complex urolithiasis, but the standard patient position for PCNL is undecided. With the patient prone PCNL has several drawbacks, while when supine, as described previously, PCNL has mechanical limitations. We describe a modification that aims to overcome these limitations and provide easy access comparable to that in the prone position.
This prospective study was carried out at the Urology Department, Zagazig University, Egypt, from October 2008 to March 2011, and included 78 patients (48 men and 30 women). First the patient was placed supine and then in the 'flank-free modified' supine position. The distance between the last rib and the iliac crest in the posterior axillary line was measured in both positions.
The mean age of the patients was 40.8 years, the mean (SD) stone diameter was 3.4 (0.7) cm, the number of right/left stones was 34/44, and mean body mass index was 28.8 kg/m(2). The mean (SD) increase in the distance between the last rib and the iliac crest in the posterior axillary line in the flank free modified supine position vs. the previous supine position was 12 (0.8) mm.
The flank-free modified supine position increases the distance between the last rib and the iliac crest, and, together with the absence of a cushion under the flank, provides ample space for puncture, dilatation, multiple tracts and manoeuvrability of the system with the nephroscope.
经皮肾镜取石术（PCNL）是治疗大的和/或复杂尿路结石的标准方法，但PCNL的标准患者体位尚未确定。患者俯卧位时PCNL有几个缺点，而如前所述，仰卧位时PCNL有机械限制。我们描述了一种改良方法，旨在克服这些限制，并提供与俯卧位相当的便捷入路。
这项前瞻性研究于2008年10月至2011年3月在埃及扎加齐格大学泌尿外科进行，纳入了78例患者（48例男性和30例女性）。首先将患者置于仰卧位，然后再置于“无侧腹改良”仰卧位。在这两种体位下测量腋后线中最后一根肋骨与髂嵴之间的距离。
患者的平均年龄为40.8岁，平均（标准差）结石直径为3.4（0.7）cm，右侧/左侧结石数量为34/44，平均体重指数为28.8kg/m²。与之前的仰卧位相比，无侧腹改良仰卧位时腋后线中最后一根肋骨与髂嵴之间距离的平均（标准差）增加量为12（0.8）mm。
无侧腹改良仰卧位增加了最后一根肋骨与髂嵴之间的距离，并且由于侧腹下方没有垫子，为穿刺、扩张、多通道操作以及使用肾镜时系统的可操作性提供了充足空间。
