不同肾造瘘管及固定方式对肾结石合并肾功能不全患者术后并发症的影响

Impacts of different nephrostomy tubes and their fixation ways on patients with nephrolithiasis complicated with renal insufficiency after percutaneous nephrolithotomy

目的:探讨不同直径的肾造瘘管及固定方式对肾结石合并肾功能不全患者经皮肾镜碎石术后并发症的影响。方法:采用随机研究方法,根据造瘘管直径和固定方式不同随机分为3组:Ⅰ组,14 Fr球囊硅胶引流管(Uro-vision)牵拉组;Ⅱ组,14 Fr球囊硅胶引流管(Urovision)不牵拉组;Ⅲ组,20 Fr无球囊乳胶引流管不牵拉组。对所有患者术前检测血清肌酐、血红蛋白、中段尿培养结果、术侧结石体积,术中记录手术时间、穿刺通道数目,计算术后24 h、72 h血红蛋白变化值,记录术后是否出现尿外渗、全身炎症反应综合征、应用毒麻药和输血情况。结果:共入选72例肾功能不全患者,每组24例。3组间在尿外渗(P=0.301)、全身炎症反应综合征(P=0.099)及应用毒麻药方面差异无统计学意义(P=0.898)。在术后24 h和72 h Hb变化值方面,Ⅰ组与Ⅱ组(P=0.001,P=0.009)、Ⅰ组与Ⅲ组(P=0.021,P=0.003)之间差异有统计学意义,Ⅱ组与Ⅲ组之间差异无统计学意义(P=0.989,P=0.962)。3组术后输血例数由低到高依次为:Ⅰ组(1例)、Ⅲ组(6例)、Ⅱ组(10例),Ⅰ组明显低于Ⅱ组(P=0.002),Ⅲ组与Ⅰ组(P=0.102)、Ⅲ组与Ⅱ组(P=0.221)之间差异无统计学意义。结论:留置14 Fr球囊硅胶肾造瘘管并牵拉压迫穿刺通道的引流方式,有利于减少结石合并肾功能不全患者术后24 h及72 h的出血量,值得推荐。

Objective：To investigate impacts of different nephrostomy tubes and their fixation ways on patients with nephrolithiasis complicated with renal insufficiency after percutaneous nephrolithotomy.Methods： A total of 72 renal insufficiency patients were enrolled in this study,who were randomized into three groups with 24 patients in each group according to nephrostomy tube diameter and its fixation way： Group Ⅰ,i.e.stretch group with 14 Fr silicon tube（Urovision）with balloon;Group Ⅱ,i.e.not strech group with 14 Fr silicon tube（Urovision）with balloon;Group Ⅲ,i.e.not strech group with 20Fr latex tube without balloon.The data collected included preoperative serum cretinine,hemoglobin value,midstream urine culture,stone volume,and operative time,and number of operative tract.It was also recorded that the change of hemoglobin between preoperation and 24 h or 72 h postoperation,presence of postoperative extravasation,systemic inflammatory respose syndrome,narcotic usage and blood transfusion.Results： There were no statistically significant differences among the three groups in terms of the incidence of postooperative extravasation（P=0.301）,SIRS（P=0.099） and narcotic usage（P=0.898）.In the aspects of the change of hemoglobin between preoperation and 24 h or 72 h postoperation,there were significant differences between group Ⅰ and groupⅡ（P=0.001,P=0.009） or group Ⅲ（P=0.021,P=0.003）.No difference was found between groups Ⅱ and Ⅲ（P=0.989,P=0.962）.In the aspect of blood transfusion cases,group Ⅰ（1 case）group Ⅲ（6 cases）group Ⅱ（10 cases）.The number of patients needing blood transfusion in group Ⅰ was significantly lower than that in group Ⅱ（P=0.002）,but the differences between group Ⅲ and group Ⅰ（P=0.102） or group Ⅱ（P=0.221） were not statistically significant.Conclusion： It is worth recommending indwelling 14 Fr silicon nephrostomy tube with balloon oppressing the operative tracts,because it could reduce blood loss 24 h and 72 h after operation in patients with nephrolithiasis complicated with renal insufficiency.