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目的:探讨碎石取石过程中的斜俯卧位微创经皮肾镜术的方法及疗效。方法:120例患者结石长径平均为3.4 cm,输尿管上段结石19例,肾盂肾盏多发性结石43例,完全或不全铸型结石58例,最大者7.8 cm×5.2 cm×3.8 cm。患者先取俯卧位,将患者的胸部和臀部及膝关节分别用宽的布带固定在手术台上,C臂X线机定位穿刺、扩张建立微创经皮肾取石通道后,让助手将手术台向患侧倾斜,与水平呈45°,形成斜俯卧位,采用输尿管镜行经皮肾镜碎石取石术。结果:120例手术均顺利完成,无穿刺失败或中转开放手术者,术中无大出血,5例术中或术后输血200～400 ml,手术时间平均86 min,首次清除率80.8%(97/120),患者在手术过程中无明显不适感,无一例出现严重并发症。23例残留结石行二期手术或ESWL碎石。出院时复查KUB显示,肾盂结石完全清除,肾盂梗阻清除率100%。结论:斜俯卧位微创经皮肾镜碎石取石可以改善患者的舒适度,有利于术中麻醉监护;碎石易快速冲洗出体外,同时可以明显降低操作者的疲劳程度,手术效果良好。
Objective: To investigate the method and efficacy of oblique percutaneous mini-percutaneous nephroscope in the process of lithotripsy. Methods: The average length of the stones was 3.4 cm in 120 patients, 19 in the upper ureteral calculi, 43 in multiple calculus of renal pelvis and calyceal calculus, and 58 in complete or partial cast stone, the largest 7.8 cm × 5.2 cm × 3.8 cm. Patients take the prone position, the patient’s chest and hips and knees were wide cloth fixed on the operating table, C-arm X-ray positioning puncture, expansion of the establishment of minimally invasive percutaneous nephrolithotomy channel, let the assistant will the operating table Slanted to the affected side, with the level was 45 °, the formation of oblique prone position, the use of ureteroscopic percutaneous nephrolithotomy lithotripsy. Results: All the 120 operations were successfully completed. There was no bleeding in operation during the operation without puncture or transfer. The intraoperative or postoperative blood transfusion was 200-400 ml in 5 cases, the average operation time was 86 min and the initial clearance rate was 80.8% (97 / 120). The patients had no obvious discomfort during the operation and no serious complications occurred. Twenty-three residual stones underwent secondary surgery or ESWL gravel. Review KUB discharged from the hospital showed complete removal of renal pelvis, pelvic obstruction clearance rate of 100%. Conclusion: The obliquely prone prone percutaneous nephrolithotomy can improve the comfort of patients and is helpful for the monitoring of intraoperative anesthesia. The gravel can be quickly washed out of the body and the fatigue of the operator can be significantly reduced. The operation effect is good.