免分腿侧卧位与截石位对输尿管软镜碎石术中肾盂内压及预后的影响

Effect of leg-split-free lateral decubitus position and lithotomy position on renal pelvic pressure and clinical outcomes during flexible ureteroscopic lithotripsy

摘要

目的：比较免分腿侧卧位与传统截石位在负压吸引鞘联合输尿管软镜碎石取石术中的肾盂内压差异及临床预后。方法：前瞻性纳入 2024 年 1 月至 2025 年 12 月在北京大学人民医院接受单侧输尿管软镜联合负压吸引鞘碎石取石术的患者。根据患者手术体位，分为免分腿侧卧位与传统截石位两组人群，术中使用智能控压控温输尿管软镜系统详细监测肾盂内压力及温度的变化，比较两组患者术中肾盂内高压的差异及对临床预后的影响。结果：共纳入 40 例患者，其中免分腿侧卧位与截石位组各 20 例。两组患者的基线特征如性别、年龄、结石直径、结石数量、位置及肾积水情况等差异无统计学意义（P>0.05）。术中数据分析显示，免分腿侧卧位组的肾盂内高压时间显著低于截石位组 $\left[25.0\right(\mathrm{0.0,31.8})\mathrm{s}$ vs. $115.0(79.8,\text{ }176.0)\mathrm{s};\text{ }\mathit{P}<0.01]$ ，并且免分腿侧卧位组的高温时间显著低于截石位组 $\left[3.0\right(\mathrm{2.0,9.8})\mathrm{s}$ vs. $18.5\left(\mathrm{16.0,24.5}\right)\mathrm{s};\text{ }\mathit{P}<0.01]$ 。术后随访数据分析显示，免分腿侧卧位组无发热患者，而截石位组患者有2例发热，但感染率差异无统计学意义（P=0.15）。所有患者术后3个月均复查 CT 以评估结石清除状态，免分腿侧卧位组的结石清除率显著高于截石位手术组（P=0.04）。结论：本前瞻性探索性研究提示，与截石位相比，免分腿侧卧位可能更有利于术中维持较低的肾盂内压及肾盂内温度，并与术后较高的清石率存在关联，但上述发现仍需大样本、多中心、随机对照试验加以验证。

Abstract

Objective：To compare intrarenal pelvic pressure profiles and clinical outcomes between the leg-split-free lateral decubitus position and the conventional lithotomy position during flexible ureteroscopy with a negative-pressure aspiration sheath. Methods：A prospective study was conducted at Peking University People＇s Hospital among patients undergoing unilateral flexible ureteroscopy with a negative- pressure aspiration sheath from January 2024 to December 2025.Participants were allocated into two groups according to surgical positioning：Leg-split-free lateral decubitus group and conventional lithotomy group.An intelligent，pressure-and temperature-controlled flexible ureteroscopy system was employed to continuously monitor intrapelvic pressure and temperature throughout the procedure.The incidence， duration，and clinical implications of intrapelvic hypertension were compared between the two groups. Results：A total of 40 patients were enrolled， 20 in each group.No statistically significant differences were observed between the groups in baseline characteristics，including gender，age，stone diameter， stone number，stone location，or degree of hydronephrosis（all P>0.05）.Intraoperative analysis re- vealed that the duration of intrapelvic hypertension was significantly shorter in the leg-split-free lateral de- cubitus group than in the lithotomy group $\left[25.0\right(\mathrm{0.0,31.8})\mathrm{s}$ vs. $115.0\left(\mathrm{79.8,176.0}\right)\mathrm{s},\mathit{P}<0.01]$ ； similarly，the duration of elevated intrapelvic temperature was also significantly reduced[3.0 （2.0,9.8） s vs.18.5（16.0，24.5）s，P<0.01].Postoperative follow-up showed no cases of fever in the leg-split- free lateral decubitus group，whereas two patients in the lithotomy group developed fever；however，this difference in febrile complication rate did not reach statistical significance (P=0.15).All the patients underwent computed tomography three months postoperatively to assess stone-free status.The results indi- cated that the stone-free rate in the leg-split-free lateral decubitus position group was significantly higher than that in the lithotomy position group (P=0.04). Conclusion：This prospective exploratory study suggests that compared with the lithotomy position，the leg-free lateral decubitus position may be more conducive to maintaining lower intrapelvic pressure and temperature during the operation and is associated with a higher stone clearance rate postoperatively.However，these findings still need to be verified by large-sample，multi-center，randomized controlled trials.

关键词

上尿路结石 / 负压鞘 / 体位 / 肾盂内高压 / 临床预后

Key words

Upper urinary tract stones / Negative-pressure sheath / Patient position / Intrarenal hyper- tension / Clinical outcomes

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