微造瘘经皮肾取石术术后不留置D-J管疗效评价  

Efficacy evaluation of stentless minimally invasive percutaneous nephrolithotomy

作　　者：顾寅珺[1] 陈奇[1] 夏磊[1] 王立鹤[1] 薛蔚[1] 黄翼然[1] 

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科,上海200127

出　　处：《现代泌尿外科杂志》2011年第2期114-116,共3页Journal of Modern Urology

摘　　要：目的探讨微造瘘经皮肾取石术(minimally invasion percutaneous nephrolithotomy,mPCNL)治疗肾结石术后单纯留置肾造瘘管的疗效及安全性。方法回顾2008年2月～2009年2月仁济医院采用微造瘘经皮肾取石术治疗肾结石80例。入选病例分为2组,标准组(术后留置肾造瘘管及D-J管)40例、不留置D-J管组(术后留置肾造瘘管,保留术中制造人工肾积水的输尿管导管,并于术后第1天拔除)40例。两组患者性别、年龄、术前感染情况、结石大小无统计学差异。统计住院时间、手术时间、医疗费用、术后发热情况、术后镇痛药需求、术后尿路刺激症状、躯体不适感等。结果标准组和不留置D-J管组在术后发热情况、术后镇痛药需求、躯体不适感、住院时间等术后并发症的发生率两组无显著差异。手术时间不留置内支架管组低于标准组。医疗费用、术后尿路刺激症不留置D-J管组显著低于标准组。结论微造瘘经皮肾取石术术后不留置D-J管是一种有效、安全的方法,减少患者术后镇痛药的使用及尿路刺激症的发生,减少手术时间,减少因导管使用及再次膀胱镜下拔管产生的医疗费用及痛苦,有利于患者尽快恢复正常生活。但病例选择需严格把握指征,要首选考虑患者的安全。Objective To evaluate the efficacy and safety of stentless minimally invasive percutaneous nephrolithotomy（mPCNL）.Methods 80 cases of mPCNL for renal calculi from Feb.2008 to Feb.2009 were reviewed.The cases were divided into 2 groups,40 in the standard group,in which nephrolithotmy tube and D-J catheter were indwelt post operation,and 40 in the stentless group,in which nephrolithotmy tube was indwelt while the ureter catheter for artificial hydronephrosis during surgery was removed one day after operation.There was no significant difference in the gender,age,preoperative infection,stone size and site between the two groups.Hospitalization,operative time,medical expenses,postoperative fever,postoperative analgesic demands,postoperative urinary tract symptoms,physical discomfort and so on were recorded.Results There was no significant difference in postoperative fever,analgesic demands,physical discomfort,and hospitalization between the two groups.The operation time for the stentless group was shorter than that for the standard group.Medical expenses and bladder stimulation symptoms of the stentless group were significantly lower than those of the standard group.Conclusion The stentless mPCNL is effective and safe,which can reduce the operative time,postoperative pain and medical expense of patients.The fewer occurrences of bladder stimulation symptoms can help patients return to normal life as soon as possible.But the indications must be carefully considered for the safety of patients.

关 键 词：微造瘘经皮肾取石术 肾结石 输尿管支架 

分 类 号：R691.4[医药卫生—泌尿科学]