即刻二期不置肾造瘘管微创经皮肾镜取石术疗效评价

A evaluation of instantly phase-Ⅱ tubeless mini-percutaneous nephrolithotomy

目的评价即刻二期不置肾造瘘管的微创经皮肾镜取石术(Instantly phase-Ⅱ tubeless MPCNL)的可行性、安全性及疗效。方法对54例上尿路结石行MCPNL,术后12～24h内在明确无需二次镜检、无明显血尿及尿路感染的情况下拔除肾造瘘管。研究结果与对照组即同一时期内行常规留置肾造瘘管的MPCNL及一期不置肾造瘘管的MPCNL(tubeless MPCNL)的患者资料进行比较。结果 54例成功施行即刻二期不置肾造瘘管的MPCNL。3组病例的年龄、结石大小、手术时间、结石清除率、平均失血量及并发症发生率差异无显著性(P>0.05),一期tubeless MPCNL和即刻二期tubeless MPCNL组术后疼痛评分、镇痛药的需求及住院时间均显著低于常规MPCNL组,差异有显著性(P<0.05)。54例患者术后无明显尿外渗及尿路感染,穿刺通道愈合良好,随访无肾周尿囊肿形成。结论对有适应证的患者施行即刻二期tubeless MPCNL安全、可行、有效。较常规留置肾造瘘管MPCNL术后疼痛不适更轻微、恢复更快,还可降低一期tubeless MPCNL术后继发出血的风险。

[Objective] To evaluate the feasibility,safety and efficacy of instantly phase-Ⅱ tubeless mini-percutaneous nephrolithotomy（MPCNL）.[Methods] The data of 54 cases receiving instantly phase-Ⅱ tubeless MPCNL were summarized retrospectively.All the nephrostomy tubes were removed at the posteroperative time of 12~24h in case of no obvious haematuria,urinary tract infection and unnecessary second endoscopic examination.All the cases were compared respectively with those who received tubeless MPCNL and standard MPCNL with placement of a nephrostomy tube.[Results] Instantly phase-Ⅱ tubeless MPCNL were performed successfully on 54 cases.The difference in the age,stones size,operation time,stone free rate,dropping in hemoglobin and complications among the three groups were not statistically significant（P 0.05）.While the visual analog pain scale scores,analgesia requirement and hospital stay of instantly phase-Ⅱ tubeless MPCNL and tubeless MPCNL were statistically significant（P 0.05） compared with the standard MPCNL.No obviously urinary tract infection,urinous extravasation and perinephric urinary cyst occurred in all instantly phase-Ⅱ tubeless MPCNL cases during follow-up and the puncture passages were all accreted well.[Conclusions] Instantly phase-Ⅱ tubeless MPCNL appeared to be feasible,safe,and effective for the indication patients.Compared with the standard MPCNL,it showed less pain,shorter hospital stay.While compared with the tubelss MPCNL,the hemorrhagic and urinous extravasation risks were avoided commendably also.