Department of Urology, NAMS, Bir Hospital, Kathmandu, Nepal.
J Nepal Health Res Counc. 2021 Apr 23;19(1):154-157. doi: 10.33314/jnhrc.v19i1.3346.
The aim of the study is the compare efficacy and safety of percutaneous nephrolithotomy in supine and prone positions. Percutaneous nephrolithotomy is conventionally performed in prone position but in recent years numbers of supine percutaneous nephrolithotomies is increasing globally.
The hospital based cross-sectional observational study was conducted in the Department of Urology, Bir Hospital from July 2018 to January 2020. A total of 81 consecutive patients undergoing percutaneous nephrolithotomy were divided into two groups, with 38 patients in Supine (Group 1) and 43 patients in Prone (Group 2) positions, respectively. Patient's demographics, access time, operative duration, stone free rate, radiation dose and duration, irrigation fluid volume, post-operative hemoglobin drop and complications were compared.
Demographic and stone characteristics were comparable in both groups. Supine Group (Group 1) had significantly shorter operative duration than Prone Group (Group 2), 44.63 ± 12.44minsvs 53.02 ±12.67mins (p< 0.04). The mean radiation duration was 99.11 ± 61.17secs in Group 1 and 108.40 ± 51.65 secs in Group 2 (p=0.46), respectively. Although the mean radiation dose was lower in Group 1 (375.1µGym2) than in Group 2 (465.7 µGym2), it was not statistically significant(p=0.24). The stone free rate at 1 month duration were comparable with 92.1% and 93.02% in Group 1 and Group 2 respectively (p=0.16). Overall complication rates were similar in both groups (15.7% in Group 1 vs 16.2% in Group 2), respectively. None of the patients in both groups had complications higher than Clavien IIIa.
PCNL in supine position has significantly shorter operative time with similar complications and stone free rates as compared to prone position.
本研究旨在比较仰卧位和俯卧位经皮肾镜取石术的疗效和安全性。经皮肾镜取石术传统上采用俯卧位，但近年来全球仰卧位经皮肾镜取石术的数量正在增加。
本医院横断面观察性研究于 2018 年 7 月至 2020 年 1 月在比勒陀利亚医院泌尿科进行。共有 81 例连续接受经皮肾镜取石术的患者分为两组，38 例患者采用仰卧位（第 1 组），43 例患者采用俯卧位（第 2 组）。比较患者的人口统计学、入路时间、手术时间、结石清除率、辐射剂量和时间、冲洗液量、术后血红蛋白下降和并发症。
两组患者的人口统计学和结石特征相似。仰卧位组（第 1 组）的手术时间明显短于俯卧位组（第 2 组），分别为 44.63 ± 12.44 分钟和 53.02 ± 12.67 分钟（p<0.04）。第 1 组的平均辐射时间为 99.11 ± 61.17 秒，第 2 组为 108.40 ± 51.65 秒（p=0.46）。虽然第 1 组的平均辐射剂量（375.1µGym2）低于第 2 组（465.7 µGym2），但差异无统计学意义（p=0.24）。第 1 组和第 2 组在 1 个月时的结石清除率分别为 92.1%和 93.02%（p=0.16），相似。两组的总体并发症发生率相似（第 1 组 15.7%，第 2 组 16.2%）。两组均无并发症高于 Clavien IIIa。
与俯卧位相比，仰卧位 PCNL 具有更短的手术时间、相似的并发症发生率和结石清除率。
