微创经皮肾镜治疗肾结石术中留置肾造瘘与无管化的比较

Comparative study of minimally invasive percutaneous nephrolithotomy in the treatment of nephrolithiasis with indwelling nephrostomy tube or tubeless

目的探讨无管化微创经皮肾镜碎石取石术(MPCNL)治疗肾结石的临床应用。方法回顾性分析我院2015年5月至2018年1月的肾结石患者资料,无管组58例结石大小(3.1±1.6)(2.2~4.8)cm。建立16 F经皮肾通道,8/9.8 F输尿管镜下碎石,清理结石无残留后,留置安全导丝至输尿管,退鞘无明显活动性出血,拔除撕开鞘,完成无管化微创MPCNL。留管组50例结石大小(3.2±1.5)(2.1~5.0)cm,手术方法与无管组相同,术后留置肾盂造瘘管。结果两组资料术前比较差异无统计学意义。两组结石患者均成功接受PCNL,手术时间无管组(72±21)(40~98)min,留管组(74±21)(46~100)min。术后次日复查血常规,两组患者均无需输血。结石清除率为98.3%(57/58)和98%(49/50),术后住院时间无管组(2.2±0.2)d,留管组(4.3±0.8)d。并发症中无管组21例患者患者术后出现38.5℃以上发热,其中6例(10.3%)退热治疗改善,15例(25.9%)抗生素治疗后改善;1例患者术后因尿外渗引起腹胀。留管组中出现18例患者38.5℃以上发热,其中5例(10%)退热治疗改善,13例(26%)抗生素治疗后改善;其余患者无其他严重并发症发生。结论无管化MPCNL治疗肾结石安全有效,并缩短住院时间。

Objective To explore the clinical application of tubeless minimally invasive percutaneous nephrolithotomy(MPCNL)in the treatment of renal calculi.Methods Clinical data of patients with renal calculi admitted to our hospital from May 2015 to January 2018 were retrospectively analyzed.In the tubeless group,the mean stone size of 58 cases was(3.1±1.6)cm(range:2.2-4.8 cm).Percutaneous renal access was established via 16 F catheter and 8/9.8 F ureteroscopic lithotripsy was performed.After complete removal of the residual stones,a guide wire was retained into the ureter,no obvious active bleeding was found after the withdrawal of peel-away sheath,and tubeless MPCNL was performed.In the tube-retaining group,the mean stone size of 50 patients was(3.2±1.5)cm(range:2.1-5.0 cm).The operation method was the same as that in the tubeless group.Pelvic fistula tube was retained after operation.Results Preoperative data did not significantly differ between two groups.All patients in two groups successfully received PCNL.The operation time was(72±21)min(range:40-98 min)in the tubeless group and(74±21)min(range:46-100 min)in the tube-retaining group.Blood routine examination was conducted at postoperative 1 d.Blood transfusion was not required in both groups.The stone removal rates were 98.3%(57/58)and 98%(49/50)in two groups.In the tubeless group,the length of hospital stay was(2.2±0.2)d and(4.3±0.8)d in the tube-retaining group.In the tubeless group,21 patients developed fever of>38.5℃after operation,6 of them(10.3%)were improved after antipyretic therapy and 15 patients(25.9%)were mitigated after antibiotic therapy.One patient suffered from abdominal distension caused by urinary extravasation after operation.In the tube-retaining group,18 patients had fever of>38.5℃,5 of them(10%)were improved after antipyretic treatment and 13 patients(26%)were alleviated after antibiotic treatment.No other serious complications occurred in other patients.Conclusion Tubeless MPCNL is safe and efficacious treatment of renal calculi,which can shorten the length of hospital stay.