Efficacy And Safety Analysis Of Percutaneous Nephrolithotomy At Oblique Lithotomy Position

Objective:To observe the clinical efficacy and safety of percutaneous nephrolithotomy in the treatment of renal calculi.Methods:160 patients with renal calculi requiring percutaneous nephrolithotomy were divided into oblique lithotomy position group(group A,n=80 cases)and prone position group(group B,n=80 cases)according to the wishes of surgeons and patients.The biochemical and imaging examinations were done before operation.There was no significant difference between the two groups in gender,age,BMI,surgical side,average stone length and diameter,average stone surface area,Guy’ s stone score and hydronephrosis degree(p>0.05).Routine blood test and abdominal CT were reexamined after the operation,and the complications such as average operation time,primary stone clearance rate,average number of renal punctures,fistulation of calyces,perirenal hematoma,and peripheral organ injury were compared between the two groups.Results: All patients completed the operation,with an average operation time of 77.5±29.5min in group A and 112.6±35.9min in group B.12 cases(15%)in group A and 4 cases(5%)in group B were perirenal hematoma.There were 6cases(7.5%)of peripheral organ injury in group A and 0 cases in group B,with the difference was statistically significant(p < 0.05).There was no significant difference between the two groups in the first-stage stone clearance rate,average hospitalization time,time to establish renal passage,number of renal punctures and other data(P>0.05).Our study also found 28 cases(35%)in group A and 6cases(7.5%)in group B through anterior calyceal approach.The incidence rate in group A was significantly higher than that in group B(p < 0.05).Further study on the complications of renal caliceal approach in the anterior group of oblique lithotomy showed: liver and spleen injury in 6 cases(21.4%),blood transfusion in 5 cases(17.9%),pleural effusion in 4 cases(14.3%),septicemia in3 cases(10.7%),perirenal hematoma in 12 cases(42.9%),significantly higher than the complications of renal caliceal approach in the posterior group(p>0.05)Conclusion: The first-stage stone clearance rate of oblique lithotomy position is similar to that of prone position PNL,but the operation efficiency of oblique lithotomy position is higher.PNL at the oblique lithotomy position may have higher risks of hemorrhage and liver and spleen injury,which may be closely related to the establishment of PNL channel at the oblique lithotomy position.