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目的探讨采用一种新型体位—“腰肋悬空”仰卧位进行经皮肾镜碎石取石术在高危(心肺功能不全)及肥胖患者中应用的安全性及有效性。方法采用该新仰卧位进行经皮肾镜碎石术治疗肾结石20例。其中男性10例,女性10例,平均年龄(55.3±10.7)岁;结石长径2~6cm,平均(2.72±1.05)cm。其中美国麻醉师协会ASA麻醉分级Ⅲ级患者12例,肥胖患者8例;均采用椎管麻醉,在B超引导下穿刺肾盂成功后,依次扩张通道至16或20F,用钬激光或三代超声将结石完全击碎。结果所有患者均穿刺成功且均能良好耐受手术,无1例患者因体位不适提前终止手术。平均手术时间为(87.90±34.98)min。一次性结石清除率达到80%,残留结石4例,其中2例二期手术取尽结石。所有患者均未输血;无胸膜、腹腔脏器损伤等并发症发生。结论采用“腰肋悬空卧位”进行超声引导下经皮肾镜碎石取石术安全有效、耐受性好,临床上有很好的应用价值。
Objective To investigate the safety and efficacy of percutaneous nephrolithotomy using high-risk (cardiopulmonary insufficiency) and obese patients with a new type of position - “lumbar dorsal vacant” supine position. Methods The new supine position for percutaneous nephrolithotomy lithotripsy in 20 cases. There were 10 males and 10 females, with an average age of (55.3 ± 10.7) years. The long diameter of the stones ranged from 2 to 6 cm (average 2.72 ± 1.05 cm). Including American Society of anesthesia ASA anesthesia grading Ⅲ patients in 12 cases, obese patients in 8 cases; are spinal anesthesia, B-guided puncture in the renal pelvis success, followed by expansion of the channel to 16 or 20F, with holmium laser or three generations of ultrasound The stone completely crushed. Results All patients were successfully punctured and well tolerated. No patient was terminated prematurely because of discomfort. The average operation time was (87.90 ± 34.98) min. Disposable stone clearance rate reached 80%, 4 cases of residual stones, of which 2 cases of second-stage operation to remove stones. No blood transfusion in all patients; no complications such as pleural injury and abdominal organ injury. Conclusion Percutaneous nephrolithotomy lithotripsy is safe, effective and well tolerated, and has good clinical value in clinical application.