完全无管化和不置肾造瘘管部分无管化经皮肾镜取石术的对照研究

Comparison of totally and partially tubeless percutaneous nephrolithotomy

目的比较完全无管化组(既不留置肾造瘘管也不留置双J管)与不置造瘘管(部分无管化,单置双J管)的经皮肾镜取石术(PCNL)的临床效果,评价完全无管化PCNL的临床可行性及应用价值。方法选择2010年11月至2011年9月符合特定筛选条件的上尿路结石患者72例,按手术次序的奇偶数分为完全无管化PCNL组和部分无管化PCNL组。比较两组患者手术时间、术后血红蛋白下降值、镇痛药物的需求、平均住院时间及并发症的发生率、医疗费用、术后恢复正常生活及工作时间等指标的区别。结果 72例患者手术均一期顺利完成,完全无管化PCNL组手术时间、术后血红蛋白下降值、镇痛药物的需求、平均住院时间及并发症的发生率等与部分无管化组PCNL组相当(P>0.05),两组在医疗费用分别为(9 566.4±523.7)元和(11 351.2±825.3)元、术后恢复正常生活及工作时间分别为(9.6±1.6)d和(16.8±1.2)d,完全无管化PCNL组要优于部分无管化PCNL组(P<0.05)。结论有条件地实施完全无管化PCNL是安全的,与部分无管化PCNL相比,并不增加术后相关并发症风险,既节约了医疗成本,又缩短了术后恢复正常生活及工作的时间,有一定的临床应用价值,值得推广应用。

Objective To compare the efficacy and value of totally tubeless percutaneous nephrolithotomy（PCNL） and partially tubeless PCNL in the treatment of urinary calculi.Methods 72 patients with upper urinary tract calculi treated between Nov.2010 to Sept.2011 were chosen as Objectives.36 of them received totally tubeless PCNL and 36 received partially tubeless PCNL.The operation time,the postoperative hemoglobin decrease,analgesia administered,hospital stay,complication incidence,medical fee and convalescence period between the two groups were compared.Results All operations were successful.There were no statistically significant differences in the operation time,the postoperative hemoglobin decrease,analgesia administered,hospital stay and complication incidence between the two groups（P0.05）.The medical fee of the totally and partially tubeless groups was（9 566.4±523.7） RMB and（11 351.2±825.3） RMB respectively（P0.05）,and the convalescence period was（9.6±1.6）d and（16.8±1.2）d（P0.05）.Conclusions Total tubeless PCNL with strictly controlled standard is safe and effective for the treatment of upper urinary tract calculi.