选择性不留置双J管无管化经皮肾镜的临床研究

Clinical study of tubeless percutaneous nephrolithotomy without indwelling double J tube

目的在经皮肾镜碎石术中应用选择性不留置双J管无管化的方式,观察其临床应用的有效性和安全性,为临床有效治疗提供理论参考依据。方法采用前瞻性随机对照研究的方法,将进行经皮肾镜碎石术的患者分为两组,观察组38例患者在经皮肾镜碎石术中应用选择性不留置双J管无管化的方式,对照组36例患者在经皮肾镜碎石术中应用常规经皮肾镜碎石术,对比观察两组患者的手术持续时间、术中出血量、结石清除率、住院时间、术后生存质量和术后并发症发生率等。结果观察组患者术中出血量为(49.58±19.21)mL,对照组为(121.38±26.94)mL;观察组住院时间为(4.76±1.01)d,对照组为(8.87±1.37)d;观察组术后生存质量得分为(98.54±6.18)分,对照组为(94.58±6.77)分;观察组术后并发症发生率(10.53%)低于对照组(38.89%),差异均有统计学意义(P<0.05)。两组患者的手术持续时间和结石清除率比较,差异无统计学意义(P>0.05)。结论在经皮肾镜碎石术中应用选择性不留置双J管无管化的方式,可以缩短手术时间,减少术中出血量,降低手术风险性,可以有效清除结石,且术后恢复快,缩短术后的住院时间,安全有效,值得进一步推广应用。

Objective To observe the effectiveness and safety of clinical application of tubeless percutaneous nephrolithotomy lithotripsy without indwelling double J tube to provide a theoretical basis for clinically effective therapy.Methods The prospective randomized controlled study method was adopted.The patients undergoing percutaneous nephrolithotomy lithotripsy were randomly divided into the two groups.38 cases in the observation group used the elective non-indwelling double J tube mode,while 36 cases in the control group used the conventional percutaneous nephrolithotomy lithotripsy.The operation duration,intraoperative blood loss,stone clearance rate,length of hospital stay,postoperative quality of life and the incidence of postoperative complications,etc.were compared between the two groups.Results The intraoperative blood loss was（49.58±19.21）mL in the observation group and（121.38±26.94）mL in the control group;the hospitalization duration was（4.76±1.01）d in the observation group and（8.87±1.37）d in the control group;the postoperative quality of life score was（98.54±6.18）points in the observation group and（94.58±6.77）points in the control group;the occurrence rate of postoperative complications in the observation group was 10.53%,which was significantly lower than 38.89%in the control group,the difference was statistically significant（P〈0.05）.The operation duration and stone clearance rate had no statistical difference between the two groups（P〉0.05）.Conclusion In percutaneous nephrolithotomy lithotripsy,applying selective nonindwelling double J tube ductless mode can shorten the operative time,reduces the intraoperative blood loss,decreases the operative risk,effectively clear stones,rapidly recovers after operation,shorten the postoperative hospitalization duration,is safe,effective and worthy being further promoted and applied.