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目的:探讨俯卧位与仰卧位采取经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)的安全性和疗效比较。方法:对9例双肾结石患者,分别分期行采用B超引导一侧俯卧和另一侧仰卧位PCNL。结果:9例患者18侧肾全部取石成功,其中3例5侧肾行二期取石。俯卧和仰卧位的手术时间、术后住院时间及一次清石率分别为(108.2±45.6)min,(116.5±31.2)min;(5.6±1.8)天,(5.8±1.5)天;66.7%(6/9),77.8%(7/9)。术中血气均无显著变化,未出现严重手术并发症。俯卧位时恶心、呕吐者8例,呼吸困难4例,肩痛5例,术中因不适药物干预7例,其中2例因不能耐受终止手术2例;仰卧位肩痛2例,未出现药物干预和因不能耐受终止手术。结论:PCNL仰卧位较俯卧位患者耐受性好、痛苦小,而两者疗效无差异,是更好的PCNL治疗体位的选择。
Objective: To investigate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in prone position and supine position. Methods: Nine patients with bilateral renal calculus were staged using B-guided ultrasonography on one side and on the other side of supine PCNL. Results: Nine patients with 18 sides of the kidney all the stone was successful, of which 3 cases of 5 side of the kidney line two stone. The time of operation, the time of hospital stay and the rate of clear stone in the prone and supine positions were (108.2 ± 45.6) min, (116.5 ± 31.2) min, (5.6 ± 1.8) days, (5.8 ± 1.5) days and 66.7% 6/9), 77.8% (7/9). Intraoperative blood gas did not change significantly, there is no serious surgical complications. Prone to nausea, vomiting in 8 cases, 4 cases of dyspnea, shoulder pain in 5 cases, intraoperative due to drug intervention in 7 cases, 2 cases were unable to tolerate termination of surgery in 2 cases; supine shoulder pain in 2 cases, did not appear Drug intervention and termination of surgery due to intolerance. Conclusions: PCNL patients in supine position are more tolerant and less painful than those in prone position, but the difference between the two is insignificant, which is a better choice for the position of PCNL.