Tsaturyan Arman, Vrettos Theofanis, Ballesta Martinez Begoña, Liourdi Despoina, Lattarulo Marco, Liatsikos Evangelos, Kallidonis Panagiotis
Department of Urology, University of Patras, Patras, Greece.
Department of Anesthesiology and ICU, University of Patras, Patras, Greece.
Minerva Urol Nephrol. 2022 Dec;74(6):695-702. doi: 10.23736/S2724-6051.22.04787-5. Epub 2022 May 27.
The aim of the current study was to perform a critical review of existing literature and report the potential morbidity of patient positioning during urological surgeries as well as evaluate the surgical outcomes and anesthesiologic benefits and risks of prone percutaneous nephrolithotomy (PCNL). A narrative review of the current literature has been performed. Articles related to position-related injuries and complications under general anesthesia in prone positions were selected, studied, and considered for the current review. We found that under general anesthesia, the prone position improved the oxygenation of patients and increased the elimination of carbon dioxide. A potential risk for position-related anesthesiologic side effects was reported for longer spine surgeries in a prone position. The injuries and position-related side effects were extremely rare following prone PCNL since the mean duration of the procedure was significantly shorter than that of spine surgery. In conclusion, the prone PCNL remains the most often utilized and preferred approach globally with well-established success and complication rates. Clinical outcomes of prone PCNL do not demonstrate an increased rate of anesthesiologic complications compared to the supine approach. Standardization of turnover of the position, and reduction of the operative time warrant a faster and complication-free recovery.
本研究的目的是对现有文献进行批判性综述，报告泌尿外科手术中患者体位摆放的潜在发病率，并评估俯卧位经皮肾镜取石术（PCNL）的手术效果以及麻醉的益处和风险。已对当前文献进行了叙述性综述。选择、研究并考虑了与俯卧位全身麻醉下与体位相关的损伤和并发症相关的文章，以进行本次综述。我们发现，在全身麻醉下，俯卧位可改善患者的氧合，并增加二氧化碳的排出。据报道，长时间的俯卧位脊柱手术存在与体位相关的麻醉副作用的潜在风险。由于俯卧位PCNL的平均手术时间明显短于脊柱手术，因此与体位相关的损伤和副作用极为罕见。总之，俯卧位PCNL仍然是全球最常用和首选的方法，其成功率和并发症发生率已得到充分确立。与仰卧位手术相比，俯卧位PCNL的临床结果并未显示麻醉并发症发生率增加。体位转换的标准化以及手术时间的缩短保证了更快且无并发症的恢复。
