何灼彬 王卫峰 丁强红

[摘要]目的 探讨斜卧-截石位与俯卧位微创经皮肾处理肾、输尿管上段结石的疗效。方法 选择我院2016年3月～2018年3月收治的112例微创经皮肾处理肾、输尿管上段结石患者，按照随机数字表法分为观察组和对照组，每组56例。所有患者均行微创经皮肾镜碎石术，其中观察组采取斜卧-截石位，对照组采取俯卧位，比较两组患者的治疗有效率、术中出血量、手术时间、住院时间以及术后并发症情况。结果 观察组患者的临床有效率显著高于对照组，差异有统计学意义（P<0.05）。观察组患者的出血量显著少于对照组，手术时间及住院时间显著短于对照组，差异有统计学意义（P<0.05）。观察组的结石清除率显著高于对照组，而术后发热率和疼痛率显著低于对照组，差异有统计学意义（P<0.05）。结论 采取斜卧-截石位行微创经皮肾处理肾、输尿管上段结石具有较好的治疗效果，能够提高结石取净率，降低术后并发症发生率，值得在临床上大力推广。

[关键词]斜卧-截石位；俯卧位；微创经皮肾镜碎石术；疗效比较

[中图分类号] R692.4 [文献标识码] A [文章编号] 1674-4721（2018）7（c）-0067-03

[Abstract] Objective To investigate therapeutic effects of the minimally invasive percutaneous nephrolithotomy of renal and ureteral calculi in recumbent-lithotomy position and prone position. Methods A total of 112 patients with kidney and upper ureteral calculi treated with minimally invasive percutaneous nephrolithotomy from March 2016 to March 2018 were selected and divided into the observation group and the control group according to the random number table methods， 56 cases in each group. All patients underwent minimally invasive percutaneous nephrolithotomy. The observation group took a recumbent-lithotomy position and the control group took a prone position. The treatment efficiency， intraoperative blood loss， operation time， hospital stay time， and postoperative complications were compared between the two groups. Results The clinical effective rate of the observation group was significantly higher than that of the control group， with significant difference （P<0.05）. The blood loss of the observation group was significantly less than that of the control group， the operation time and length of stay were significantly shorter than those of the control group， with significant difference （P<0.05）. The stone clearance rate of the observation group was significantly higher than that of the control group， and postoperative fever rate and pain rate were significantly lower than that of the control group， and the difference was statistically significant （P<0.05）. Conclusion The therapeutic effects of minimally invasive percutaneous nephrolithotomy of renal and ureteral calculi in recumbent-lithotomy position and prone position is better， which can improve the stone removal rate and reduce the incidence of postoperative complications. It is worthy of clinical promotion.

[Key words] Recumbent-lithotomy position； Prone position； Minimally invasive percutaneous nephrolithotomy； Efficacy comparison

近年來，随着人们生活水平的不断提高，人们的饮食习惯也发生了改变，肾结石的发生率逐年升高。腔镜技术不断的发展，使得经皮肾镜碎石术成为临床上治疗肾结石的最佳手段，俯卧位微创经皮肾镜碎石术虽然已成为一种较为成熟的技术，但患者俯卧位下的舒适度较差，术中长时间的操作也会导致患者呼吸困难及机体血流动力学发生改变，而该体位下，麻醉师对患者的观察监测也较为困难[1-3]，因此，寻找合适的体位用于肾结石患者的碎石手术就显得非常重要。有学者采用斜卧位和仰卧位进行手术，在临床上取得了较好的效果，但存在需先行在截石位对患者进行输尿管逆行插管，然后再变换体位，操作较为繁琐[4-5]。本研究采取斜卧-截石位行微创经皮肾镜碎石术对患者肾、输尿管上段的结石进行碎石治疗，取得了较好效果和预后，为肾结石患者手术体位的选择提供了依据，现报道如下。……