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目的探讨不同体位下微创经皮肾镜取石术治疗输尿管上段结石患者的临床效果。方法选取2012年6月至2014年6月河南省新乡医学院第三附属医院收治的90例输尿管上段结石患者为研究对象,按随机数字表法将其分为俯卧位、仰卧位及45°斜仰卧位组,每组30例。3组患者均行微创经皮肾镜取石术,观察并记录3组患者体位变化前后心率(HR)、收缩压(SBP)及舒张压(DBP),同时记录其建立通道时间、手术时间、术中出血量、一次性清石率、并发症发生情况。结果体位变化后,俯卧位组患者的SBP及DBP均明显低于仰卧位组、斜仰卧位组,差异均有统计学意义(均P<0.05);斜仰卧位患者手术时间明显短于仰卧位组、俯卧位组,术中出血量明显少于仰卧位组及俯卧位组,差异均有统计学意义(均P<0.05);斜仰卧位患者的一次性清石率明显高于仰卧位组及俯卧位组,差异有统计学意义(P<0.05)。结论 45°斜仰卧位下微创经皮肾镜取石术治疗输尿管上段结石临床效果更显著,具有手术时间短、术中出血量少、1次性清石率高的特点。
Objective To investigate the clinical effect of minimally invasive percutaneous nephrolithotomy on patients with upper ureteral calculi under different positions. Methods Ninety patients with upper ureteral calculi treated in the Third Affiliated Hospital of Xinxiang Medical College of Henan Province from June 2012 to June 2014 were selected as study subjects and classified into prone position, supine position and 45 ° inclined Supine group, 30 cases in each group. The 3 groups of patients underwent minimally invasive percutaneous nephrolithotomy to observe and record heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the change of body position in the 3 groups. Meanwhile, the time of establishing the channel, the operation time, Intraoperative bleeding, one-time rate of clear stones, complications occurred. Results SBP and DBP in prone position patients were significantly lower than those in supine position and oblique supine position (P <0.05, respectively) after the position changes. The operation time in patients with oblique supine position was significantly shorter than that in supine position Group, prone position group, intraoperative blood loss was significantly less than the supine position group and prone position group, the differences were statistically significant (all P <0.05); oblique supine patients with clear stone was significantly higher than supine group And prone position group, the difference was statistically significant (P <0.05). Conclusion The clinical effect of minimally invasive percutaneous nephrolithotomy lithotripsy under 45 ° oblique supine position is more significant, with the advantages of short operative time, less intraoperative blood loss and high rate of primary clear stone.