经皮肾镜下碎石术后肾造瘘管夹闭与开放时机的选择

Suitable Time for Clipping the Nephrostomy Tube after Percutaneous Nephrolithotomy

目的:探讨经皮肾镜下碎石术(percutaneous nephrolithotomy,PCNL)术后肾造瘘管夹闭和开放时机对机体的影响,以期为结石的治疗及相关研究提供参考。方法:采用Excel软件Rand函数,将2010年6月—2012年6月符合入选标准的80例患者随机分为2组:开放组(n=40)和夹闭组(n=40)。开放组患者术后夹闭肾造瘘管至第1天晨8点后开放肾造瘘管;夹闭组患者术后夹闭肾造瘘管夹闭至拔管。比较2组患者术后血白细胞数、血红蛋白值、术后疼(胀)感评分、术后尿液外渗、发热情况及患者、家属关注造瘘管等情况。结果:2组患者的术中输血率、术后血白细胞数、血红蛋白、术后疼痛及胀痛视觉模拟评分(visual analogue scale,VAS)、镇痛药物应用比例、尿液外渗比例、发热比例差异无统计学意义。2组家属询问造瘘管事件比例、造瘘管堵塞发生比例比较,差异有统计学意义(P<0.05)。结论:术后夹闭肾造瘘管的止血作用可能仅限于术后早期,且与患者术后手术部位疼(胀)感无关。对于排除了明显存在泌尿系感染的患者,术后持续夹闭肾造瘘管不增加感染的风险。夹闭肾造瘘管直至拔管可以避免肾造瘘管堵塞且不会引起尿液外渗增加,这对减轻患者及家属对造瘘管相关问题的担忧有积极的意义。

Objective：To investigate the effect on patients for different clipping time of nephrostomy tube after percutaneous nephrolithotomy（PCNL）and to provide reference for doctors engaging in treating urinary stone.Methods：According to Excel software Rand function,a total of 80 patients who met the inclusion criteria were divided into 2 groups with 40 patients in every group.The nephrostomy tubes of 40 patients were opened at 8：00 in the first day post-surgery after clipping（openning group）,and the other 40 patients would keep clipping the tubes till the tubes were removed（clipping group）.The white blood cell count and hemoglobin,visual analogue scale（VAS）,urinary extravasation rate,fever rate and the rate of inquiry on the nephrostomy tube by the patients or families after surgery.Results：No statistically significant differences were found in blood transfusion rate,white blood cell count,hemoglobin,VAS score,analgesia use rate,urinary extravasation rate and fever rate after PCNL between 2 groups.However,the rate of inquiry on the nephrostomy tube and the blockage of nephrostomy tube were obviously more in openning group than that in clipping group（P＜0.05）.Conclusions：Clipping the nephrostomy tube till the tube is removed after operation can decrease blood loss only in the early stage after PCNL,and that doesn＇t aggravate or alleviate pain or swell feeling.Clipping the nephrostomy tube till the tube is removed doesn＇t increase the infection risk for the patients excluding the obvious infected individuals.Clipping the tube can avoid the blockage of nephrostomy tube,and meanwhile doesn＇t increase the urinary extravasation.It＇s useful to alleviate the worry of patients or their families about nephrostomy tube.