CAJ | 학술논문

目的：比较改良Valdivia体位和传统俯卧位经皮肾镜取石术（ PCNL）的疗效及安全性。方法回顾性分析2012年12月至2014年9月80例接受PCNL治疗肾结石患者的临床资料。根据手术体位，将患者分为两组：改良Valdivia体位组44例，俯卧位组36例。两组年龄、性别、麻醉分级、结石直径[（27．7±4．3）和（28．3±3．9） mm]等比较差异均无统计学意义（P＞0．05）。对两组总手术时间、多通道使用率、失血量、并发症发生率及结石清除率等进行比较。结果80例手术均穿刺成功，无中转开放，无结肠损伤、胸膜腹膜穿孔、死亡等严重并发症。俯卧位组有1例因结石体积较大、手术时间过长（130 min），患者气道内压过高而中止手术，1周后行二期PCNL。改良Valdivia体位组总手术时间为（67．7±24．5） min，短于俯卧位组的（91．5±29．8） min，差异有统计学意义（P＜0．05）。两组多通道使用率[14％（6／44）和22％（8／36）]、血红蛋白下降值[（1．3±0．2）和（1．4±0．7） g／L]、并发症发生率[18％（8／44）和19％（7／36）]及结石清除率[80％（35／44）和86％（31／36）]比较差异均无统计学意义（ P＞0．05）。结论改良Valdivia和俯卧位PCNL治疗肾结石均安全、有效，前者总手术时间较短。
목적：비교개량Valdivia체위화전통부와위경피신경취석술（ PCNL）적료효급안전성。방법회고성분석2012년12월지2014년9월80례접수PCNL치료신결석환자적림상자료。근거수술체위，장환자분위량조：개량Valdivia체위조44례，부와위조36례。량조년령、성별、마취분급、결석직경[（27．7±4．3）화（28．3±3．9） mm]등비교차이균무통계학의의（P＞0．05）。대량조총수술시간、다통도사용솔、실혈량、병발증발생솔급결석청제솔등진행비교。결과80례수술균천자성공，무중전개방，무결장손상、흉막복막천공、사망등엄중병발증。부와위조유1례인결석체적교대、수술시간과장（130 min），환자기도내압과고이중지수술，1주후행이기PCNL。개량Valdivia체위조총수술시간위（67．7±24．5） min，단우부와위조적（91．5±29．8） min，차이유통계학의의（P＜0．05）。량조다통도사용솔[14％（6／44）화22％（8／36）]、혈홍단백하강치[（1．3±0．2）화（1．4±0．7） g／L]、병발증발생솔[18％（8／44）화19％（7／36）]급결석청제솔[80％（35／44）화86％（31／36）]비교차이균무통계학의의（ P＞0．05）。결론개량Valdivia화부와위PCNL치료신결석균안전、유효，전자총수술시간교단。
Objective To compare the efficacy and safety of percutaneous nephrolithotomy ( PCNL) in modified supine Valdivia and traditional prone positions for the treatment of renal stones.Methods Clinical data of 80 consecutive patients with renal calculi who accepted PCNL from December 2012 to September 2014 were retrospectively reviewed.They were divided into modified supine Valdivia group ( n=44) and prone position group (n=36) according to the position during surgery.There was no significant difference between the 2 groups in age, sex, ASA class, stone location and size (P>0.05).Total operative time, ratio of multi-access, blood loss, perioperative complications and stone-free rate were compared between the 2 groups.Results All punctures were performed successfully.No case was converted to open surgery.No severe complications such as colon injury, pleura or peritoneum perforation, or death occurred intra-and post-operatively.In prone position, 1 patient was found to develop high intra-trachea pressure because of large stone burden and prolonged operative time (130 min).This procedure was stopped and the patient received the second session of PCNL 1 week later.The mean total operative time was significantly shorter in the modified supine than in the prone position ( 67.7 ±24.5 min versus 91.5 ±29.8 min, P<0.05).There were no significant differences in ratio of multi-access (14% versus 22%), mean blood loss (1.3 ±0.2 g/L versus 1.4 ±0.7 g/L), incidence of complications (18% versus 19%), and stone clearance rate ( 80% versus 86%) between the 2 groups ( P >0.05 ) .Conclusion PCNL in modified supine Valdivia is as safe and effective as that of prone position for the treatment of renal stones, but the former is more time-saving than the latter.