Ⅰ期经皮肾镜碎石取石术后持续留置肾造瘘管对Ⅱ期经皮肾镜碎石取石手术的影响分析

Analysis of the Influence of Nephrostomy Tube on Second-stage Percutaneous Nephroscopy

目的评估Ⅰ期经皮肾镜碎石取石术后持续留置肾造瘘管对Ⅱ期经皮肾镜碎石取石手术患者的影响。方法收集福建省立金山医院泌尿外科自2016年02月至2020年01月收治的行Ⅱ期经皮肾镜碎石取石术的患者39例,将患者分为Ⅰ期术后持续留置肾造瘘管组(持续带管组)和Ⅰ期术后无持续留置肾造瘘管组(无持续带管组),其中持续带管组23例,无持续带管组16例。回顾性分析比较两组患者的Ⅱ期住院相关指标。结果持续带管组Ⅱ期术前尿细菌培养阳性率显著高于无持续带管组Ⅱ期术前尿细菌培养阳性率(P=0.000)。持续带管组Ⅱ期术前尿细菌复合感染率显著高于无持续带管组Ⅱ期术前尿细菌复合感染率(P=0.029)。持续带管组Ⅱ期住院时间显著长于无持续管组的Ⅱ期住院时间(P=0.000)。两组间Ⅱ期术前尿真菌感染率、Ⅱ期术前产ESBL细菌感染率、Ⅱ期手术时间、Ⅱ期住院输血率、Ⅱ期手术结石清除率、Ⅱ期术后泌尿系感染发生率、Ⅱ期住院碳青霉烯类抗生素使用率差异均无统计学意义(P>0.05)。结论Ⅰ期经皮肾镜碎石取石术后持续留置肾造瘘管,未明显提高结石清除效果和降低出血风险,可增加患者泌尿系感染风险,延长住院时间,降低患者就医体验。

Objective To investigate the effect of the continuous indwelling of the nephrostomy tube after the first-stage percutaneous nephrolithotomy on the related indicators of hospitalization in patients with the second-stage percutaneous nephrolithotomy.Methods 39 patients who underwent second-stage percutaneous nephrolithotomy in the Department of Urology of Fujian Jinshan Hospital from February 2016 to January 2020 were collected,and the patients were divided into the first-stage postoperative continuous indwelling nephrostomy group group(With-tube group)and one-stage postoperative no continuous indwelling nephrostomy tube group(no-tube group),including 23 cases in the tube group and 16 cases in the no tube group.We retrospectively analyzed two-stage hospitalization indicators between the two groups.Results The positive rate of the second-stage preoperative urine bacterial culture in the tube group was significantly higher than that in the non-tube group(P=0.000).The preoperative combined urine bacterial infection rate in the tube group was significantly higher than that in the non-tube group(P=0.029).The second-stage hospital stay in the tube group was significantly longer than that in the no tube group(P=0.000).The differences of second-stage preoperative urinary fungal infection rate,ESBL bacterial infection rate,operation time,blood transfusion rate,stone removal rate,urinary tract infection rate and the use rate of carbapenem antibiotics between the non-tube group and with-tube group were not statistically significant(P>0.05).Conclusions Long-term indwelling of the nephrostomy tube after the first-stage percutaneous nephrolithotomy did not significantly improve the effect of stone removal and reduce the risk of bleeding.However,It can increase the risk of urinary tract infections,prolong hospitalization,thereby reducing the patient experience.