经皮肾镜碎石术部分无管化安全性及可行性的探讨

Safety and feasibility of partial tubeless percutaneous nephrolithotripsy

目的探讨经皮肾镜碎石术部分无管化(PCNL)的安全性和临床疗效。方法选取安徽医科大学附属巢湖医院2021年1月—2023年6月收治的87例肾输尿管结石患者,按照手术方式分为传统经皮肾镜(留置肾造瘘管和双J管)手术组47例和经皮肾镜部分无管化(仅留置双J管)手术组40例。所有87例手术均由同一组医生完成,比较2组术前和围手术期资料,分析经皮肾镜手术并发症的影响因素。结果传统经皮肾镜手术组术后住院时间[7.00(6.00,9.00)d vs.5.00(4.00,6.00)d]、首次下床时间[4.00(3.00,5.00)d vs.2.00(2.00,3.00)d]、术后并发症发生率[17例(36.2%)vs.3例(7.5%)]、术后VAS评分[7.00(7.00,8.00)分vs.5.00(5.00,5.00)分]与经皮肾镜部分无管化手术组比较差异均有统计学意义(P<0.05)。除性别外,2组术前年龄、BMI、STONE评分、术前尿白细胞、合并糖尿病、高血压、心脏病比较,差异均无统计学意义(P>0.05)。多因素分析显示,结石STONE评分与手术方式是术后并发症的独立影响因素。结论经皮肾镜部分无管化在手术安全性、术后VAS评分、术后恢复时间、住院时间、治疗费用、治疗效率方面具有显著优势,值得推广。

Objective To investigate the safety and clinical efficacy of partial tubeless percutaneous nephrolithotripsy(PCNL).Methods A total of 87 patients with renal ureteral stones admitted to the Chaohu Hospital of Anhui Medical University between January 2021 to June 2023 were divided into 47 cases in the traditional percutaneous nephrolithotomy(with indwelling nephrostomy tube and double J-tube)surgical group and 40 cases in the percutaneous nephrolithotomy partially untubed(with indwelling double J-tube only)surgical group according to surgical methods.All 87 surgical pro-cedures were performed by the same surgical team.The data pertaining to the preoperative and perioperative periods,a-long with the factors that may potentially influence the incidence factors that may potentially influence the incidence of complications associated with percutaneous nephrolithotomy were comparable between the two groups.Results In the traditional percutaneous nephroscopic surgery group,the postoperative hospitalization duration[7.00(6.00,9.00)d vs.5.00(4.00,6.00)d],first time out of bed[4.00(3.00,5.00)d vs.2.00(2.00,3.00)d],incidence of postoperative complications[17 cases(36.2%)vs.3 cases(7.5%)]and postoperative VAS score[7.00(7.00,8.00)vs.5.00(5.00,5.00)]were significantly different from those in the percutaneous nephroscopic partial tubeless surgery group(P<0.05).With the exception of gender,the two groups exhibited statistically significant differences in preoperative age,BMI and STONE score.Preoperative urinary leukocytes,comorbidities of diabetes mellitus,hyperten-sion,and cardiac disease did not reach statistical significance(P>0.05).A multifactorial analysis revealed that STONE score and surgical approach were independent risk factors for postoperative complications.Conclusion Percutaneous nephrolithotomy for partial tubelessness offers significant advantages in terms of surgical safety,postoperative VAS score,postoperative recovery time,average hospital stay,treatment cost,and treatment efficiency.It is therefore a procedure that merits further promotion.