经皮肾镜取石术后不留置肾盂造瘘管的疗效评价

Efficacy of percutaneous nephrolithotomy without keeping nephrostomy drainage

目的评价经皮肾镜取石术（PCNL）后不放置肾盂造瘘管的疗效。方法输尿管上段或肾结石行PCNL患者240例。男147例，女93例。年龄19~64岁，平均（48．5士9．4）岁。结石直径1．2～5．6cm，平均（2．8土1．2）cm。患者入选标准：术前无尿路感染病史、单通道、碎石术中无明显出血、无需行二次经皮肾操作者。随机分2组：A组（n=120）术后不放置肾盂造瘘管，B组（n=120）术后放置14F肾盂造瘘管。比较2组患者术后疼痛程度、需应用镇痛药例数、术后住院时间及漏尿发生率。结果240例患者均一期手术成功。A组术后6h、第1天、第2天的疼痛评分分别为4．2±1．5、2．1±1．6和1．2±1．0，均显著低于B组的5．5±2．4、3．9±1．5和2．5±1．5，P值均〈0．01；A组需使用镇痛药者18例，B组为32例（15．0％与26．7％，P〈0．05），A组术后发生尿漏3例，B组28例（2．5％与23．3％，P〈0.01），术后住院时间A组（1．7±0．6）d，B组（3．1±1．1）d，P〈0．01。结论对于无尿路感染、一期手术、单通道、术中无明显出血的患者，PCNL术后不放置肾盂造瘘管可减轻患者痛苦和经济负担、缩短患者恢复时间，是安全可行的治疗方法。

Objective To evaluate the efficacy of percutaneous nephrolithotomy （PCNL） for upper ureteric calculi or renal calculi without keeping nephrostomy drainage. Methods A total of 240 patients with upper ureteric calculi or renal calculi undergoing PCNL were selected and randomized to receive no nephrostomy drainage （Group A, 120 patients） or a standard （14 F） nephrostomy drainage （Group B, 120 patients） after lithotripsy was finished. Inclusion criteria included no urinary infection history, one-stage operation, single percutaneous tract, no operative bleeding and no need for second percutaneous operation. The pain score, the number of patients requiring postoperative analgesia and the incidence of urine leakage as well as postoperative hospital stay time of the 2 groups were noted and compared. Results Compared with Group B, patients in Group A got lower pain scores at 6 h, 1 d and 2 d after the operation （4.2±1.5, 2.1±1.6 and 1.25=1.0 vs 5.5±2.4, 3.9±1.5 and 2.5±1.5, respectively, P〈0.01）, with fewer patients requiring postoperative analgesia （15.0% vs 26.7%, P〈0.05）, lower incidence of urine leakage （2.5% vs 23.3%, P〈0.01） and shorter postop- erative hospital stay （1.7±0.6 d vs 3.1±1.1 d, P〈0.01）. Conclusion For selected patients, take away nephrostomy drainage right after PCNL could be considered as an effective method to get less postoperative pain, lighter economic burden and shorter recovery time.