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目的探讨肥胖及高危患者患侧腰部抬高45°仰卧位经皮肾镜碎石清石术(percutaneous nephrolithotomy,PCNL)的临床价值。方法总结2004年7月～2011年9月我院102例肥胖及高危肾输尿管上段结石患者患侧腰部抬高45°仰卧位PCNL的临床资料,肥胖25例,BMI 24～34;高危77例,合并中重度肺部疾患、高血压病、糖尿病及慢性肾功能不全等。肾结石77例,长径2.2～5.5 cm;输尿管上段结石25例,长径1.5～2.6 cm。PCNL时联合应用气压弹道以及超声碎石。结果 102例均顺利完成手术,无中转开放,无胸膜损伤及周围脏器损伤等并发症。术后4～10天复查X线、B超或CT,结石清除率89.2%(91/102)。11例肾盂或肾盏残余结石,最大径1.1～1.8 cm,行ESWL碎石。结论患侧腰部抬高45°仰卧位PCNL对肥胖及高危肾输尿管上段结石患者安全、可行。
Objective To investigate the clinical value of supine abdominal percutaneous nephrolithotomy (PCNL) with elevation of 45 ° in obese and high-risk patients. Methods From July 2004 to September 2011, 102 patients with obesity and high-risk renal proximal ureteral calculi in our hospital were enrolled in this study. Clinical data of PCNL elevation of 45 ° in the lumbar region were obtained. Twenty-five obese patients with BMI 24-34 and 77 high- Combined with severe lung disease, hypertension, diabetes and chronic renal insufficiency. There were 77 cases of kidney stones with a long diameter of 2.2-5.5 cm. 25 cases of upper ureteral stones with a long diameter of 1.5-2.6 cm. PCNL when combined with pneumatic ballistic and ultrasonic lithotripsy. Results All the 102 cases were successfully completed the operation, no transfer to open, no complications of pleural injury and surrounding organ injury. 4 to 10 days after the review of X-ray, B ultrasound or CT, stone clearance rate of 89.2% (91/102). 11 cases of renal pelvis or calyceal residual stones, the largest diameter 1.1 ~ 1.8 cm, ESWL gravel. Conclusions PCNL elevation of 45 ° in the lumbar region is safe and feasible for obesity and upper ureteral calculi in high risk patients.