Department of Medicine, Monash University, Melbourne, Australia.
Department of Medicine, Monash Health, Casey Hospital, Berwick, Australia.
Investig Clin Urol. 2016 Jul;57(4):268-73. doi: 10.4111/icu.2016.57.4.268. Epub 2016 Jul 5.
The traditional prone positioning of percutaneous nephrolithotomy (PCNL) is associated with various anesthetic and logistic difficulties. We aimed to compare the surgical outcomes of PCNLs performed using our modified supine position with those performed in the standard prone position.
A prospective group of 236 renal units (224 patients) undergoing PCNL were included in this 2 site study: 160 were performed in the modified supine position were compared with 76 undergoing PCNL in the prone position. The outcomes of radiation dose, radiation time, stone free rate, body mass index (BMI), stone size, operative time, length of stay (LOS), in hospital and complications were compared. Chi-square and t-tests were used.
There were no significant differences in mean radiation time, radiation dose or stone size between the modified supine and prone groups. The supine group had a higher mean BMI (31 kg/m(2) vs. 28 kg/m(2), p=0.03), shorter mean surgical time (93 minutes vs. 123 minutes, p<0.001), shorter mean LOS (2 days vs. 3 days, p=0.005) and higher stone free rate (70% vs. 50%, p=0.005). There were no differences in septic or bleeding complications but the prone group had a higher rate of overall complications.
Modified supine PCNL has significantly lower operative time, shorter LOS and higher stone-free rate compared with prone in our series, while remaining a safe procedure.
传统的经皮肾镜取石术（PCNL）俯卧位与各种麻醉和后勤困难有关。我们旨在比较使用改良仰卧位进行 PCNL 与标准俯卧位进行 PCNL 的手术结果。
这项 2 地点研究纳入了 236 个肾单位（224 例患者）接受 PCNL 的前瞻性组：160 例采用改良仰卧位进行比较，76 例采用俯卧位进行比较。比较辐射剂量、辐射时间、结石清除率、体重指数（BMI）、结石大小、手术时间、住院时间（LOS）、住院时间和并发症。使用卡方检验和 t 检验。
改良仰卧位和俯卧位组的平均辐射时间、辐射剂量或结石大小无显著差异。仰卧位组的平均 BMI 较高（31kg/m2 与 28kg/m2，p=0.03），平均手术时间较短（93 分钟与 123 分钟，p<0.001），平均 LOS 较短（2 天与 3 天，p=0.005）和结石清除率较高（70%与 50%，p=0.005）。在感染或出血并发症方面没有差异，但俯卧组的总并发症发生率较高。
在我们的系列中，改良仰卧位 PCNL 与俯卧位相比，手术时间显著缩短，LOS 更短，结石清除率更高，同时仍然是一种安全的手术。
