摘要
目的:通过与常规留置肾造瘘管的微创经皮肾镜取石术(mini-percutaneous nephrolithotomy,MPCNL)的效果比较,评价不置肾造瘘管的MPCNL(tubeless MPCNL)的临床价值。方法:选择2003年1月～2009年7月收治的上尿路结石患者345例,115例行tubeless MPCNL(A组),230例行常规留置肾造瘘管的MPCNL(B组)。并比较两组患者的手术时间、术中出血量、结石清除率、术后对镇痛药的需求、住院天数、并发症和医疗费用等指标。结果:A组均获得成功,其中11例行完全无管化的MPCNL(不留置肾造瘘管和双J管),13例行双侧同期tubeless MPCNL。其结石大小、手术时间、结石清除率、平均失血量及并发症发生率等与B组相当(P>0.05),但术后疼痛评分、镇痛药的需求、医疗费用及住院时间等均优于B组(P<0.05)。结论:对有适应证的上尿路结石患者行tubeless MPCNL安全、可行,部分患者还可行完全无管化的MPCNL。与常规留置肾造瘘管的MPCNL相比,tubeless MPCNL术后疼痛轻,恢复快,费用低,住院时间短。
Objective： To evaluate the clinical value of tubeless mini-percutaneous nephrolithotomy（tubeless MPCNL） as compared with conventional MPCNL with routine placement of nephrostomy tubes. Methods： From January 2003 to July 2009, 345 patients with upper urinary calculus who underwent MPCNL were included in this study. The patients were divided into two groups, 115 receiving tubeless MPCNL （group A） and 230 receiving conventional MPCNL with routine placement of nephrostomy tubes （group B）. The frequency of complications, length of hospital stay, stone clearance, operative time, blood loss, analgesic requirement and hospital cost were assessed. Results：Tubeless MPCNL was performed successfully in 115 cases, 11 cases of whom received totally tubeless MPCNL, and 13 cases of whom with bilateral disease underwent simultaneous bilateral tubeless MPCNL. When two groups were compared with regard to stone volume, operative time, stone clearance, blood loss and complications rate, no significant differences were found （P~〉0. 05）. Conversely, significant differences were found between the two groups in terms of the visual analog pain scale scores, analgesia requirement, hospitalization time and hospital cost （P〈0. 05）. Conclusions： It seems that tubeless MPCNL may be a safe, effective and feasible method for upper urinary calculus treatment in selected patients. In comparison with conventional MPC- NL, tubeless MPCNL has some potential advantages of decreased postoperative pain, analgesia requirement and hospital stay without increasing the complications. Some cases can also receive totally tubeless MPCNL.
出处
《临床泌尿外科杂志》
北大核心
2010年第11期818-820,共3页
Journal of Clinical Urology
关键词
尿路结石
微创经皮肾镜取石术
肾造瘘管
urinary lithiasis
mini-percutaneous nephrotlthotomy
nephrostomy tube
