The choice of body position for percutaneous nephrolithotomy, changes of vital signs during operation and the occurrence of complications after operation

Abstract

Objective To investigate the choice of body position for percutaneous nephrolithotomy (PCNL) and the effect on hemodynamics and complications during operation. Methods The medical records of 75 patients with urinary tract stones treated by PCNL were analyzed retrospectively. According to the body position during operation, the patients were divided into the prone position group (n=31) and the lateral recumbent position group (n=44). The operation time, length of hospital stay, stage I stone clearance rate and the incidence of complications were compared between the two groups. The mean arterial pressure (MAP) and heart rate (HR) before anesthesia (T0), after prone position or lateral recumbent position (T1), at 30 min after the beginning of operation (T2) and at the end of operation (T3), airway pressure and intra-abdominal pressure at T0, T1 and T3 were compared. Results There were no significant differences between the two groups in length of hospital stay, stage I stone clearance rate and postoperative complications (P>0.05). The operation time of prone position group was longer than lateral recumbent position group (P<0.05). Compared with T0, MAP were lower at T1-T3, and the decrease was more obvious in the prone position group (P<0.05). Compared with T0, airway pressure and intra-abdominal pressure increased in the prone position group at T1 and T3, and was significantly higher than that of the lateral recumbent position group (P<0.05). Conclusions The stage I stone clearance rates of the two kinds of body positions are basically the same, but the lateral recumbent position of PCNL is superior to the prone position in shortening the operation time, maintaining the hemodynamic stability, reducing the intra-abdominal pressure and the fluctuation of airway pressure. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Lithotripsy; Posture; SYMPTOMS & SIGNS; Postoperative Complications