Comparative study on percutaneous nephrolithotomy for staghorn renal
calculi in the oblique supine lithotomy position and prone position

doi:10.3760/cma.j.issn.1007-1245.2022.12.013

Abstract

Abstract:

Objective　To explore the safety and efficacy of percutaneous nephrolithotomy (PCNL) for staghorn renal calculi in the oblique supine lithotomy position and prone position. Methods　A retrospective analysis was performed on 180 patients with staghorn renal calculi from January 2012 to April 2020, all of whom were treated with PCNL, including 100 cases from The Fifth Affiliated Hospital of Guangzhou Medical University (group A) and 80 cases from The Sixth Affiliated Hospital of Guangzhou Medical University (group B). In group A, there were 43 males and 57 females, aged (53.42±10.71) years, undergoing surgery in the prone position; in group B, there were 34 males and 46 females, aged (52.83±11.25) years, undergoing surgery in the oblique supine lithotomy position. The puncture site, operative time, intraoperative bleeding volume, stage Ⅰ stone-free rate, hospital stay, hemodynamic changes (systolic blood pressure, diastolic blood pressure, and heart rate) were observed and compared in the two groups. t test was used for the measurement data and χ² test was used for the count data. Results　There were no statistically significant differences in the puncture site and stage Ⅰ stone-free rate between the two groups (both P>0.05). The operative time and hospital stay of group B were (90.13±17.70) min and (10.15±1.54) d, respectively, which were lower than those of group A [(107.25±45.55) min and (14.92±5.23) d], with statistically significant differences (both P<0.05). The incidence of postoperative serious complications in group B was 0.00% (0/80), which was lower than that in group A [6.00% (6/100)], with a statistically significant difference (P<0.05). There were no statistically significant differences in the systolic blood pressure, diastolic blood pressure, and heart rate between the two groups 30 min before anesthesia (T₀) and after anesthesia (T₁) (all P>0.05). The systolic blood pressure of group B was (132.00±13.50) mmHg (1 mmHg=0.133 kPa) at intraoperative 25th min (T₂) and (128.97±11.84) mmHg at extubation (T₃), respectively, the diastolic blood pressures were (80.24±9.88) mmHg and (80.56±7.93) mmHg, respectively, which were higher than those of group A [(125.24±15.63) mmHg, (123.84±15.65) mmHg, (75.94±13.92) mmHg, and (73.93±10.25) mmHg], with statistically significant differences (all P<0.05). The systolic blood pressure of group A at T₀ and T₁ were (138.30±16.83) mmHg and (134.72±17.56) mmHg, the diastolic blood pressures were (84.00±13.00) mmHg and (81.23±12.84) mmHg, respectively, which were higher than those at T₂ [(125.24±15.63) mmHg and (75.94±13.92) mmHg], with statistically significant differences (all P<0.05). There was no statistically significant difference in the heart rate between groups or within groups (all P>0.05). Conclusion　The clinical effects of PCNL for patients with staghorn renal calculi in the oblique supine lithotomy position and prone position are similar, and the operative time and hospital stay in the oblique supine lithotomy position were significantly shorter than those in the prone position with higher safety.

Key words: Staghorn renal calculi, Percutaneous nephrolithotomy, Oblique supine lithotomy position, Prone position

摘要： 目的　探讨比较肾鹿角形结石截石斜仰卧位及俯卧位下经皮肾镜碎石取石术的治疗效果。方法　回顾性分析2012年1月至2020年4月肾鹿角形结石患者180例，均用经皮肾镜碎石术治疗，广州医科大学附属第五医院100例（A组）和广州医科大学附属第六医院80例（B组）。A组男43例、女57例，年龄（53.42±10.71）岁，采取俯卧位；B组男34例、女46例，年龄（52.83±11.25）岁，采取截石斜仰卧位。观察并比较两组患者穿刺部位、手术时间、术中出血量、Ⅰ期结石清除率、住院日、血流动力学（收缩压、舒张压及心率）改变。计量资料采用t检验，计数资料采用χ²检验。结果　两组穿刺部位和Ⅰ期结石清除比较，差异均无统计学意义（均P>0.05）；B组手术时间、住院日分别为（90.13±17.70）min、（10.15±1.54）d，均低于A组（107.25±45.55）min、（14.92±5.23）d，差异均有统计学意义（均P<0.05）。B组术后严重并发症发生率为0.00%（0/80），低于A组6.00%（6/100），差异有统计学意义（P<0.05）。麻醉前30 min（T₀）、麻醉成功后（T₁），两组患者收缩压、舒张压、心率比较，差异均无统计学意义（均P>0.05）；术中25 min（T₂）、拔管时（T₃），B组收缩压分别为（132.00±13.50）mmHg（1 mmHg=0.133 kPa）、（128.97±11.84）mmHg，舒张压分别为（80.24±9.88）mmHg、（80.56±7.93）mmHg，均高于A组的（125.24±15.63）mmHg、（123.84±15.65）mmHg及（75.94±13.92）mmHg、（73.93±10.25）mmHg，差异均有统计学意义（均P<0.05）；A组T₀、T₁时收缩压分别为（138.30±16.83）mmHg、（134.72±17.56）mmHg，舒张压分别为（84.00±13.00）mmHg、（81.23±12.84）mmHg，与T₂时（125.24±15.63）mmHg、（75.94±13.92）mmHg比较，差异均有统计学意义（均P<0.05）；组内和组间心率比较，差异均无统计学意义（均P>0.05）。结论　肾鹿角形结石患者经皮肾镜碎石术采用截石斜仰卧位和俯卧位的效果相当，但截石斜仰卧位较俯卧位能显著缩短手术时间和住院日，且手术更安全。

关键词: 肾鹿角形结石, 经皮肾镜碎石取石术, 截石斜仰卧位, 俯卧位

Jiang Ganggang, Zeng Peng, Lan Ziquan, Yang Jianggen, Huang Guixiao, Jiang Xianhan. Comparative study on percutaneous nephrolithotomy for staghorn renal calculi in the oblique supine lithotomy position and prone position[J]. International Medicine and Health Guidance News, 2022, 28(12): 1684-1688.

姜刚刚, 曾鹏, 蓝子权, 杨江根, 黄桂晓, 江先汉. 肾鹿角形结石截石斜仰卧位及俯卧位下经皮肾镜碎石取石术的研究[J]. 国际医药卫生导报, 2022, 28(12): 1684-1688.

References

[1] 谭军,杨国胜,张涛,等. 组合式输尿管软镜与电子输尿管软镜治疗10～20mm肾下盏结石的临床疗效比较[J]. 现代泌尿外科杂志,2019,24(8):649-653. DOI:10.3969/j.issn. 1009-8291.2019.08.011.

[2] 刘军,何炜,项立波,等. 直径2～3 cm肾结石患者经输尿管软镜钬激光碎石术与经皮肾镜取石术的临床效果比较[J]. 广西医科大学学报,2020,37(3):501-506. DOI:10.16190/j.cnki.45-1211/r.2020.03.030.

[3] 刘笑,杨小平,周冬平.单通道微创经皮肾镜联合逆行输尿管软镜钬激光碎石术治疗复杂性肾结石临床观察[J].现代医院,2019,19(11):1653-1655. DOI:10.3969/j.issn.1671- 332X.2019.11.029.

[4] 朱澄村,程帆,饶婷,等.输尿管软镜碎石术治疗上尿路结石的疗效和安全性[J].中华泌尿外科杂志,2020,41(1):41-45.

[5] Randad A, Ghanem MA, Bailey MR, et al. Design, fabrication, and characterization of broad beam transducers for fragmenting large renal calculi with burst wave lithotripsy[J].J Acoust Soc Am,2020,148(1):44. DOI:10.1121/10.0001512.

[6] 吕文伟,魏澎涛,张寒,等. 负压组合式输尿管镜与输尿管软镜钬激光碎石术治疗单侧上尿路结石的对比研究[J]. 国际医药卫生导报,2021,27(6):871-874. DOI:10.3760/cma.j.issn.1007-1245.2021.06.021.

[7] Cracco CM, Scoffone CM, Scarpa RM. New developments in percutaneous techniques for simple and complex branched renal stones[J].Curr Opin Urol,2011,21(2):154-160. DOI:10.1097/MOU.0b013e3283436d32.

[8] Agrawal MS, Agarwal K, Jindal T, et al. Ultra-mini-percutaneous nephrolithotomy: a minimally-invasive option for percutaneous stone removal[J].Indian J Urol,2016,32(2):132-136. DOI:10.4103/0970-1591.174778.

[9] 李卓航,谢伟槟,刘成,等. 斜跨位超微通道经皮肾镜的疗效分析[J/CD]. 中华腔镜泌尿外科杂志(电子版),2020,14(4):246-248. DOI:10.3877/cma.j.issn.1674-3253. 2020. 04.002.

[10] Pastore AL, Palleschi G, Silvestri L, et al. Combined laparoscopic pyelolithotomy and endoscopic pyelolithotripsy for staghorn calculi: long-term follow-up results from a case series[J].Ther Adv Urol,2016,8(1):3-8. DOI:10.1177/1756287215607417.

[11] 曾晖,陈洪波,赵纯雄. 鹿角形肾结石外科常用治疗技术新进展[J/CD]. 世界最新医学信息文摘(连续型电子期刊),2019,19(52):77,81. DOI:10.19613/j.cnki.1671-3141. 2019.52.040.

[12] 郑煜,李建新,周兴. SonixGPS导航超声与普通超声引导下经皮肾镜治疗肾结石的疗效比较[J/CD]. 中华腔镜泌尿外科杂志(电子版),2019,13(1):20-23. DOI:10.3877/cma.j.issn.1674-3253.2019.01.005.

[13] Zeng G, Wan S, Zhao Z, et al. Super-mini percutaneous nephrolithotomy (SMP): a new concept in technique and instrumentation[J].BJU Int,2016,117(4):655-661. DOI:10.1111/bju.13242.

[14] Chen L, Sha ML, Li D, et al. Treatment for residual stones using flexible ureteroscopy and holmium laser lithotripsy after the management of complex calculi with single-tract percutaneous nephrolithotomy[J].Lasers Med Sci,2017,32(3):649-654. DOI:10.1007/s10103-017-2162-5.

[15] Antonelli JA, Beardsley H, Faddegon S, et al. A novel device to prevent stone fragment migration during percutaneous lithotripsy: results from an in vitro kidney model[J].J Endourol,2016,30(11):1239-1243. DOI:10.1089/end.2016.0466.

[16] Sofer M, Giusti G, Proietti S, et al. Upper calyx approachability through a lower calyx access for prone versus supine percutaneous nephrolithotomy[J].J Urol,2016,195(2):377-382. DOI:10.1016/j.juro.2015.07.101.

[17] Singh V, Garg Y, Sharma K, et al. Prospective randomized comparison between superior calyceal access versus inferior calyceal access in PCNL for inferior calyceal stones with or without pelvic stones[J].Urolithiasis,2016,44(2):161-165. DOI:10.1007/s00240-015-0805-1.

[18] Karaolides T, Moraitis K, Bach C, et al. Positions for percutaneous nephrolithotomy: thirty-five years of evolution[J].Arab J Urol,2012,10(3):307-316. DOI:10.1016/j.aju.2012.06.005.

[19] 潘铁军,张加桥,李功成,等. "腰肋悬空"仰卧位经皮肾镜术在高危及肥胖患者中的应用[J]. 现代泌尿外科杂志,2011,16(3):219-221. DOI:10.3969/j.issn.1009-8291. 2011. 03.010.

[20] Cracco CM, Scoffone CM. ECIRS (Endoscopic Combined Intrarenal Surgery) in the Galdakao-modified supine Valdivia position: a new life for percutaneous surgery?[J].World J Urol,2011,29(6):821-827. DOI:10.1007/s00345-011-0790-0.

[21] 李道兵,罗旭,付逆,等. 截石卧位经皮肾镜取石术治疗复杂性肾结石的探讨(附36例报告)[J]. 中国内镜杂志,2011,17(9):988-989,992.

[22] Yuruk E, Binbay M, Ozgor F, et al. Comparison of shockwave lithotripsy and flexible ureteroscopy for the treatment of kidney stones in patients with a solitary kidney[J].J Endourol,2015,29(4):463-467. DOI:10.1089/end.2014.0613.

[23] 褚勇,孙云,桑海明,等. 分析肾结石治疗中采用侧卧位微创经皮肾镜碎石术的临床治疗效果[J]. 中国农村卫生,2018(14):39-40. DOI:10.3969/j.issn.1674- 361X.2018.14.041.

[24] 王发有. 侧卧位微创经皮肾镜碎石术在肾结石治疗中的临床价值[J]. 中国现代医生,2018,56(36):45-47.

[25] 殷全忠,袁宝国,赵化利. 俯卧位、仰卧位及45°斜仰卧位行经皮肾镜碎石术的疗效分析[J]. 中国临床研究,2015,28(5):606-608. DOI:10.13429/j.cnki.cjcr.2015.05.020.

[26] 汪英亮. 探讨肾结石患者俯卧位及半截石斜仰卧位在经皮肾镜碎石术中的应用效果[J]. 中国医药指南,2018,16(19):141. DOI:10.15912/j.cnki.gocm.2018.19.107.

[27] 朱智能,袁敬东,章传华. 超声引导下多角度斜仰卧位经皮肾镜取石术治疗伴脊柱畸形上尿路结石[J]. 微创泌尿外科杂志,2019,8(1):17-20. DOI:10.19558/j.cnki.10-1020/r.2019.01.004.

[28] 黄俊波. 斜仰卧位经皮肾镜碎石术效果分析[J]. 中外医疗,2020,39(18):65-67. DOI:10.16662/j.cnki.1674-0742. 2020.18.065..

[29] Inanloo SH, Yahyazadeh SR, Rashidi S, et al. Feasibility and safety of ultrasonography guidance and flank position during percutaneous nephrolithotomy[J].J Urol,2018,200(1):195-201. DOI:10.1016/j.juro.2018.02.074.

[30] 张卫生. 不同手术体位经皮肾镜术治疗复杂性肾结石时患者血流动力学及疗效对比观察[J]. 医学理论与实践,2018,31(1):63-65. DOI:10.19381/j.issn.1001-7585.2018. 01.032.

[31] 郑卓敏,庄泽平,李冕华,等. 不同手术体位在老年肥胖患者经皮肾镜取石术中的应用效果观察[J]. 中国医药科学,2016,6(9):210-213.

[32] 李英,江广学,李建梅,等. 经皮肾镜碎石术体位的选择和摆置对手术的影响[J]. 微创医学,2011,6(3):250-252. DOI:10.3969/j.issn.1673-6575.2011.03.031.

Comparative study on percutaneous nephrolithotomy for staghorn renal calculi in the oblique supine lithotomy position and prone position

肾鹿角形结石截石斜仰卧位及俯卧位下经皮肾镜碎石取石术的研究

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