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目的探讨俯卧位、仰卧位及45°斜仰卧位在B超引导下行经皮肾镜碎石术(PCNL)的疗效,为临床治疗选择合适的体位提供依据。方法回顾性分析2012年10月至2014年8月收治的57例患者的临床资料,按手术体位分为俯卧位组、仰卧位组、45°斜仰卧位组3个组。通过观察评价患者体位舒适度,患者手术建立通道时间、手术时间、术中出血量、Ⅰ期结石清除率,结肠损伤率及术后感染率等指标,分析比较3组临床疗效。结果仰卧位组(5.2%)和45°斜仰卧位组(5.6%)患者重度不适发生率明显低于俯卧位组(30.0%),3组比较差异有统计学意义(P<0.01)。手术时间、术中出血量、Ⅰ期结石清除率等指标45°斜仰卧位组明显低于俯卧位组和仰卧位组,3组比较差异有统计学意义(P<0.05,P<0.01)。45°斜仰卧位组结肠损伤率(0)稍低于俯卧位组(10.0%)和仰卧位组(15.8%),但差异无统计学意义(P>0.05);45°斜仰卧位组术后感染率(0)稍低于俯卧位组(5.0%)和仰卧位组(10.5%),但差异亦无统计学意义(P>0.05)。结论 B超引导下行PCNL术选择45°斜仰卧位较俯卧位、仰卧位更为安全可行,该体位下能有效增强患者的手术耐受力,减少术中出血量。
Objective To investigate the curative effect of percutaneous nephrolithotomy (PCNL) in prone position, supine position and 45 ° supine position under B-guided ultrasonography, so as to provide a basis for selecting suitable position for clinical treatment. Methods The clinical data of 57 patients admitted from October 2012 to August 2014 were retrospectively analyzed. According to the surgical position, they were divided into three groups: prone position group, supine position group and 45 ° oblique supine position group. The clinical efficacy of the three groups were analyzed and compared through the observation and evaluation of the patient’s comfort level, the time of establishing the operation channel, operation time, intraoperative blood loss, stage I stone clearance, colon injury rate and postoperative infection rate. Results The incidence of severe discomfort in supine position group (5.2%) and 45 ° supine position group (5.6%) was significantly lower than that in prone position group (30.0%). There was significant difference between the three groups (P <0.01). Operation time, intraoperative blood loss, grade Ⅰ stone clearance and other indicators of 45 ° supine position was significantly lower than the prone position and supine position group, the difference between the three groups was statistically significant (P <0.05, P <0.01). The colonic injury rate in the 45 ° oblique supine group was slightly lower than that in the prone supine position (10.0%) and supine position group (15.8%), but the difference was not statistically significant (P> 0.05) Post infection rate (0) was slightly lower than that in the prone group (5.0%) and supine group (10.5%), but the difference was not statistically significant (P> 0.05). Conclusions The B-guided PCNL underwent a 45 ° oblique supine position and a supine position more safely and feasibly. Under this position, the patient’s operative tolerance can be effectively enhanced and the amount of intraoperative bleeding can be reduced.