微创经皮肾镜取石术后不留置肾造瘘管的临床观察  

Clinical evaluation of tubeless minimally invasive percutaneous nephrolithotomy

作　　者：吴松[1] 赖海标[1] 钟亮[1] 黄智峰[1] 曾晔[1] 李森[1] 赖伟业[1] 郑东翔[1] 唐荣志[1] 

机构地区：[1]广州中医药大学附属中山医院泌尿外科,广东中山528400

出　　处：《徐州医学院学报》2008年第6期397-399,共3页Acta Academiae Medicinae Xuzhou

摘　　要：目的探讨微创经皮肾镜取石术（MPCNL）后常规放置肾造瘘管的必要性。方法56例肾结石患者,MPCNL中无严重的出血或并发症且无需行二期MPCNL,对其术后不放置肾造瘘管的可行性进行分析。结果56例患者中,MPCNL结石清除率87.5%（49/56）;7例（12.5%）结石残留;经体外冲击波碎石（ESWL）结石排净,结石总清除率100%。平均手术时间45 m in,平均血红蛋白水平下降14.2 g/L（5～38 g/L）。2例患者术后输血400 ml。15例患者术后给予哌替啶75 mg。平均住院时间3天,无大出血、漏尿及邻近器官损伤等并发症发生。结论MPCNL术后常规放置肾造瘘管是不必要的,部分非复杂性MPCNL术后不放置造瘘管能够减少术后止痛剂的使用,缩短住院天数。Objective To discuss the necessity for routine placement of nephrostomy tube after minimally invasive percutaneous nephrolithotomy （MPCNL） for renal calculi. Methods A total of 56 patients with renal calculi were amenable to MPCNL, without serious hemorrhage or intraoperative complications. No nephrostomy tube was placed at the conclusion of the procedure and no second - stage MPCNL was required. Feasibility of this tubeless MPCNL was retrospectively analyzed. Results 49 patients （87.5%） were stone free while 7 patients （ 12.5% ） had residual fragments which were further eliminated by extra-corporeal shock wave lithotripsy （ESWL）. The total stone - free rate reached 100%. Operating time ranged from 25 to 100 min （mean = 45 min）. The mean reduction in hemoglobin level was 14.2 g/L （ranged 5-38 g/L） and only 2 patients received postoperative blood transfusion of 400 ml. Only 15 patients received 75 mg of pethidine for the pain. Hospitalization period ranged from 2 and 5 days （ mean = 3 days）. No complication （hemorrhage, urine leakage or injuries to adjacent organs） was observed in any case. Conclusion Routine placement of nephrostomy tube after MPCNL for renal calculi is unnecessary. In properly selected patients, tubeless MPCNL is preferable for the reduced pain - killer cost and shortened hospitalization period.

关 键 词：经皮肾镜取石术 肾结石 肾造瘘管 

分 类 号：R692.4[医药卫生—泌尿科学]