Tubeless-PCNL处理输尿管上段结石的有效性和安全性

Effectiveness and Safety of Tubeless-PCNL in Treatment of Upper Ureteral Calculi

目的探讨留置输尿管外支架的微通道无管化经皮肾镜取石术(tubeless-PCNL)治疗输尿管上段结石的临床效果。方法回顾性分析本院泌尿外科2012-2014年手术治疗的120例输尿管上段结石患者的临床诊治方法,其中采用传统PCNL手术治疗57例(传统组)、采用tubeless-PCNL手术治疗63例(tubeless-PCNL组),统计分析2组患者的手术指标、术后康复及并发症指标的差异。结果 tubeless-PCNL组患者的手术时间(59.3±9.2)min、术后24 h VAS评分(2.40±0.81)分、镇痛剂使用率(6.4%)、住院时间(6.3±1.5)d均显著低于传统组患者的手术时间(62.4±8.9)min、术后24 h VAS评分(3.96±1.27)分、镇痛剂使用率(24.6%)、住院时间(7.6±1.8)d,差异具有统计学意义(P<0.05,P<0.01)。tubeless-PCNL组患者的肾周积液率(11.11%)、术后尿急率(3.2%)、血尿发生率(7.9%)、腰痛发生率(4.8%)均显著低于传统组患者,差异具有统计学意义(P<0.05)。结论 Tubeless-PCNL治疗输尿管上段结石具有手术时间短、术后恢复快、疼痛程度低、并发症率低的优势。

Objective To explore the clinical effect of percutaneous renal lithotripsy （tubeless-PCNL） with a micro channel of indwelling ureteral stents on the treatment of ureteral calculi. Methods The clinical diagnosis and treatment of 120 cases of ureteral calculi patients were analyzed retrospectively in a hospital between 2012 and 2014. Among these cases, 57 received tra- ditional PCNL surgery （traditional group）, and 63 received tubeless-PCNL treatment （tubeless-PCNL group）. Indications for surgery, postoperative recovery and complications were statistically analyzed between the two groups. Results The operation time （59.3±9.2） rain, postoperative 24h VAS score（2.40±0.81 ） ,analgesic usage（6.35% ） ,length of hospital stay（6.3±1.5 ） d of patients in tubeless-PCNL group were significantly lower than those in traditional group, and the difference was statistically significant （P〈0. 05, P〈0.01 ）. There was no significant difference in hemoglobin （P〉0.05）, HCT or fever between the two groups . The incidence of perirenal effusion（ 11.1% ） ,postoperative urgent urination（3.2% ） ,hematuria（7.9% ） ,low back pain （4.8%） of patients in tubeless-PCNL group was significantly lower than in traditional group, and the difference was statistically significant（P〈 0.05 ）. Conclusion Tubeless-PCNL treatment of upper ureteral calculi has the advantages of a short operation time, quick recovery, low degree of pain and low complication rate.