腰肋悬空仰卧位经皮肾镜碎石术在有肾结石开放手术史患者的应用

目的 研究腰肋悬空仰卧位经皮肾镜碎石术在既往有肾结石开放手术史患者应用的安全性和有效性.方法 2008年12月至2011年12月我院采用腰肋悬空仰卧位经皮肾镜碎石60例,其中有既往肾结石开放手术史30例,无肾开放手术史30例,收集两组患者术前年龄、性别、身体质量指数（BMI）、结石负荷、结石位置、手术间隔时间;记录术中是否输血、血红蛋白下降水平、术后住院时间、穿刺进入肾集合系统时间、手术时间;记录术后发热、败血症、内脏器官损伤、碎石成功率、是否辅助治疗、术后8 h的视觉模拟评分法（VAS）的疼痛评分等,同时比较两组上述各参数的差异.结果 两组患者在年龄、性别、BMI、结石负荷、结石位置、手术间隔时间术中出血、是否输血、住院时间方面无统计学差异,而在穿刺进入肾集合系统时间（25.0±1.5）min vs.（15.0±1.2）min]、手术时间（95±5）min vs.（80±6）min]在有肾结石手术史组明显长于无开放肾结石手术史组,有统计学差异（P＜0.05）;两组患者在术后发热、败血症、内脏器官损伤、碎石成功率、是否辅助治疗、术后8h的VAS疼痛评分无统计学差异.结论 腰肋悬空仰卧经皮肾镜碎石术患者在整个手术过程中具有更少的体位变动、较短的悬空和胸廓、内脏器官受压、较好的气道管理,因而对既往有开放肾结石手术史的患者是一种安全、有效的手术方式.

Supine percutaneous nephrolithotomy for kidney stones in patients with a history of open operation

Objective To study the safety and efficacy of supine position percutaneous lithotripsy to treat kidney stones for patients with previous open operation.Methods Data of 60 cases treated in our hospital with supine position percutaneous nephrolithotomy during Dec.2008 to Dec.2011 were retrospectively analyzed.Of the 60 cases,30 had a history of open surgery for kidney stones and the other 30 patients hadn’t.The age,gender,BMI,stone burden,stone location,surgical interval,intraoperative blood transfusion,decreased hemoglobin level,postoperative hospital stay,time needed to puncture into the renal collecting system,operation time,postoperative fever,sepsis,visceral organ damage,stone clearance rate,adjuvant therapy and 8-hour VAS pain scores of the two groups of patients were compared and analyzed.Results Of all the parameters,there were differences in the time needed to puncture into the renal collecting system (25±1.5) min vs.(15±1.2 min)] and the operation time (95±5) min vs.(80±6 min)],indicating that patients with history of open surgery needed longer time to puncture and operate.Conclusions During supine percutaneous lithotripsy,patients have few body position changes,little chest and internal organ pressure,and good airway management,thus supine percutaneous lithotripsy is safe and effective for patients with previous open surgery.