微创经皮肾镜钬激光碎石术后不留置肾造瘘管的临床效果

A randomized comparison of tubeless and standard minimally invasive percutaneous nephrolithotomy

目的探讨经皮肾镜钬激光碎石术后不留置肾造瘘管必要性和安全性。方法符合研究标准的62例肾结石患者随机分成两组,1组术后不保留肾造瘘管,2组术后保留肾造瘘管,术中无明显活动性出血或并发症,两组术毕均留置双J管。结果 1组结石清除率90.3%,2组结石清除率93.5%,差异无统计学意义(P>0.05);1组平均手术时间(48.68±10.33)min,2组平均手术时间(47.58±12.15)min,差异无统计学意义(P>0.05);1组术后平均住院日(2.94±0.57)d,2组术后平均住院日(4.52±0.72)d,差异有统计学意义(P<0.05);1组术后需镇痛率22.6%,2组术后需镇痛率54.8%,差异有统计学意义(P<0.05)。结论经皮肾镜碎石术术后留置肾造瘘管并非必需,对于部分非复杂性肾结石微创经皮肾镜碎石术术后不留置肾造瘘管能缩短住院天数减少术后疼痛。

Objective To evaluate the safety, effectiveness, and feasibility of tubeless minimally invasive percutaneous nephrolithoto- my （MPCNL） for renal calculi. Methods A total of 62 patients with renal stones were enrolled in this study. Patients ,which considered un- complicated and suitable, were randomized to either a tubeless approach （ group 1 ） or placement of an F 16 nephrostomy tube （ group 2）. The hospital stay, analgesic requirements, operative time and stone-free rates were compared in 2 groups. Results The stone-free rate was 90.3 % vs 93.5% for group 1 and 2,respectively （P 〉0.05）. The mean operative time was 48.68 ±10.33 minutes and 47.58 ± 12.15 minutes for group 1 and 2 respectively （ P 〉 0.05 ）. The mean hospitalization time was 2.94 ± 0.57 and 4.52± 0.72 days for group 1 and 2 （ P 〈 0.01 ）, and the mean analgesia requirement rate was 22.6% and 54.8 for group 1 and 2 respectively （P 〈 0. 05 ）. Conclusion Tubeless PCNL is safe and effective procedure for renal stones. The hospitalization and analgesic requirements are less than standard PCNL. Routine placement of nephrostomy tube after MPCNL for renal calculi is not necessary. However, the tubeless decision should be taken intraoperatively in selected patients.