无管化微造瘘经皮肾镜取石术治疗肾和输尿管上段结石

Tubeless mini-percutaneous nephrolithotomy in the treatment of renal and ureteral calculi

目的探讨无管化微造瘘经皮肾镜取石术治疗肾和输尿管上段结石的疗效及安全性,评估无管化微创手术的优势。方法采用微造瘘经皮肾镜取石术治疗肾和输尿管上段结石150例,入选病例随机分为2组,无管化组75例,标准组75例,两组性别、年龄无统计学差异。统计手术时间、住院时间、医疗费用、结石清除率、术后镇痛药需求等指标。结果无管化组和标准组平均手术时间、结石清除率、感染、输血等并发症的发生率无显著性差异(P>0.05);住院时间、医疗费用、术后疼痛程度、镇痛药的需求及恢复正常生活时间无管化组显著低于标准组(P<0.05)。结论无管化微造瘘经皮肾镜取石术是治疗肾和输尿管上段结石的一种有效、经济、安全的方法。

Objective To explore and evaluate the efficacy and safety of tubeless mini-percutaneous nephrolithotomy （mini-PNL） in the treatment of renal or upper ureteral calculi. Methods 150 cases diagnosed as renal or upper ureteral calculi underwent mini-PNL at Renji hospital. Of these 150 PNLs, 75 received neprhostomy tube-free modification and the others insertion of the nephrostomy after the operation. There were no statistical significant differences in sex and age between the groups. Operative time, hospital stay, cost, analgesia requirement and convalescence period were compared in both groups. Results No statistical significant differences were found with the time of operation, stone clearance rate, complication incidence between the tubeless group and the standard one. However, the tubeless group had much more advantages in hospital stay, cost, pain, analgesia requirement and convalescence period. Gonclusion Tubeless mini-PNL is an effective and safe treatment of renal or upper ureteral calculi with shorter hospital stay, lower cost, less analgesia requirement, shorter recovery time. Nevertheless, the safety of the patients must be the first consideration. The selection of the patient must be very strict.