无管化经皮肾镜治疗肾和输尿管上段结石

Tubeless percutaneous nephrolithotomy in treatment of renal and proximal ureteral calculi

目的探讨无管化经皮肾镜碎石取石术(PCNL)治疗肾和输尿管上段结石的安全性、可行性和禁忌证。方法回顾性研究中山大学附属第三医院·岭南医院泌尿外科2016年11月至2018年5月80例PCNL患者临床资料,已排除脓肾结石患者,根据是否留置肾造瘘管分组:患者术后输尿管内留置双J管,同时留置肾造瘘管40例(传统PCNL组),术后只留置双J管,无留置肾造瘘管40例(无管化PCNL组)。结果两组患者年龄、肾和输尿管结石位置和结石负荷、肾积水直径、总手术时间和结石清除率等差异比较均无统计学意义。患者术后第一天疼痛评分(VAS)试验组比对照组低(3.4±0.9 vs 5.6±1.4),平均住院时间与对照组比较缩短(7.9±1.4 vs 8.8±1.6)d,差异均有统计学意义(P<0.05)。结论无管化PCNL治疗非脓性肾输尿管上段结石安全可行,且可减轻患者术后疼痛,缩短住院时间。

Objective To investigate efficacy and safety of tubeless percutaneous nephrolithotomy(PCNL) for the treatment of renal stone and proximal ureteral calculi. Methods From Nov. 2016 to May. 2018, the data of 80 inpatients without pyonephrosis underwent PCNL in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University, were retrospectively evaluated. One group treated with traditional PCNL(D-J tube and nephrostomy tube, 40 cases) and the other with tubeless PCNL(D-J tube only and without nephrostomy tube, 40 cases). Results There was no significant difference between the two groups for the age, calculi location, stone load, diameter of hydronephrosis, total operative time and stone free rate(P>0.05). The mean postoperative VAS pain score and length of hospital stay were significantly lower and shorter in the tubeless PCNL group compared with the standard PCNL group [(3.4±0.9 vs 5.6±1.4);(7.9±1.4 vs 8.8±1.6) days;P<0.05]. Conclusion Tubeless PCNL is safe and effective for managing renal and proximal ureteral calculi without pyonephrosis, which has the advantage of reducing postoperative pain and shortening hospital stay.