不同体位对肾结石经皮肾镜碎石术疗效与安全性的影响

摘要

Objective To investigate the effect of different surgical body position on the efficacy and safety of percutaneous nephrolithotomy (PCNL). Methods 70 patients with renal calculus who underwent PCNL in our hospital from January 2010 to January 2015 were included. All the patients underwent B ultrasonic examination and CT examination to identify the di-agnostic criteria for renal calculi. All the patients were divided into two groups with 35 in each one according to different surgical body positions. Patients in group A adopted prone position, while those in group B adopted oblique 45° supine po-sition. The clinical curative effect and postoperative complication rate were compared between the two groups. Results Be-fore the body position was changed, no statistically significant difference can be found in the level of HR, DBP and SBP be-tween the two groups, P>0.05; after the body position was changed, the level of HR of all the patients showed no obvious change, P>0.05, but the level of SBP, DBP of all the patients decreased in varying degree, and among them the levels of SBP and DBP were evidently lower in group A than in group B, and the differences was statistically significant, P<0.05. The one-time stone clearance rate was obviously higher, and the operation duration and intraoperative blood loss were obviously lower in group B than in group A, and the differences were statistically significant, P<0.05. No statistically significant dif-ference can be found in postoperative complication rate between the two groups, P>0.05. Conclusion Oblique 45° supine position is conducive to stabilizing blood pressure and improving operation duration, intraoperative blood loss and one-time stone clearance rate, and can reduce postoperative complication rate, therefore this body position is worthy of clinical appli-cation and promotion.%目的：探讨不同体位对肾结石经皮肾镜碎石术（PCNL）疗效与安全性的影响。方法随机选取该院2010年1月—2015年1月期间肾结石PCNL患者70例，全部患者经B超、CT检查明确肾结石的诊断标准，根据不同的手术体位将患者分为两组，各35例，A组患者采用俯卧位，B组患者采用45°斜仰卧位，组间比较临床疗效与术后并发症发生率的差异。结果体位改变前，全部患者SBP、DBP与HR水平比较差异无统计学意义（P＞0.05），体位改变后，全部患者HR水平无明显改变（P＞0.05），全部患者SBP、DBP水平均呈不同程度的降低，其中A组SBP、DBP水平明显低于B组，比较差异具有统计学意义（P＜0.05）。B组一次清石成功率明显高于A组，手术时间、术中出血量明显低于A组（P＜0.05），组间比较差异具有统计学意义（P＜0.05）。组间术后并发症发生率比较差异无统计学意义（P＞0.05）。结论45°斜仰卧位有助于稳定血压水平，改善手术时间、术中出血量与一次清石成功率，且不增加术后并发症发生风险，值得临床推广应用。