速即纱封闭经皮肾通道可行性和安全有效性的随机对照研究  

Feasibility, safety and efficacy of Surgicel Sealant in tubeless percutaneous nephrolithotomy:A randomized controlled trial

作　　者：余强国[1] 甘艺平[1] 宋小松[1] 范召应[1] 肖玮琳[1] 吴荣 

机构地区：[1]佛山市南海区第二人民医院泌尿外科,广东省528251

出　　处：《中华临床医师杂志（电子版）》2013年第23期223-226,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨经皮肾镜取石术(PCNL)术后应用速即纱(Surgicel?)封闭经皮肾通道的可行性和安全有效性。方法 2012年10月至2013年10月行PCNL患者,术中取石完毕后,随机分为试验组(速即纱组)和对照组(传统PCNL组)。排除肾盂穿刺液为脓性、集合系统严重穿孔或需二期PCNL取石者后,共60例患者被纳入研究,试验组和对照组各30例,所有手术均由同一位医师完成。比较两组患者术后疼痛、Hb和HCT下降量、输血率、尿外渗及肾周血肿发生率、住院时间等。结果两组患者年龄、性别、结石大小、肾积水程度、术前Hb和HCT差异均无统计学意义。试验组术后平均住院时间3.23 d,对照组7.02 d,术后疼痛视觉模拟评分(VAS)试验组为2.36,对照组为5.12,两组差异均有统计学意义(P<0.01);两组术后Hb和HCT下降量、手术时间、结石清除率及发热发生率差异无统计学意义(P>0.05)。两组无肾周血肿、尿漏发生,无需输血病例。结论 PCNL术后应用速即纱封闭经皮肾通道安全、有效、可行,可预防通道出血和尿外渗,有助于拓展无管化PCNL的应用范围。Objective To assess the Feasibility, safety and efficacy of using oxidized cellulose hemostats （Surgicel？） in tubeless percutaneous nephrolithotomy. Methods Patients undergoing PCNL were randomized to either the placement of a Surgicel？ sealant in the nephrostomy tract （experimental group） or traditional PCNL with tube drainage （control group） at the end of the procedure. Patients with stone residual requiring a second PCNL, pyonephrosis and severe perforation of collecting system were excluded from study. A total of 60 patients were enrolled in this study, 30 patients in experimental group and control group respectively. All procedures were performed by a single urologist. The two groups were compared with respect to postoperative pain, hemoglobin and hematocrit changes, blood transfusion rate, incidence of extravasation and perirenal hematoma, and hospital stay. Results The mean age, sex, stone burden, preoperative hemoglobin, hematocrit and serum creatinine values were not significantly different between the two groups. The average hospital stay in the experimental group （3.23 d） was significantly shorter than that in control group （7.02 d） （P＆lt;0.01）. Patients in the experimental group experienced less postoperative pain than that in control group （the average visual analogous scale, VAS 2.36 vs. 5.12, P＆lt;0.01）. There was no difference in the postoperative hemoglobin and hematocrit decrease, serum creatinine values, operation time, stone clearance and fever rate in the 2 groups（P＆gt;0.05）. There was no incidence of urine leakage and perirenal hematoma in the 2 groups, and no blood transfusion requirement. Conclusions Sealing the nephrostomy tract with Surgicel？ after PCNL is an safety, available, and feasible method for preventing bleeding and urine leakage postoperatively in selected patients receiving PCNL, thus allowing the extension of indications for tubeless percutaneous nephrolithotomy to most procedures.

关 键 词：止血 肾造口术 经皮 漏尿 无管化 

分 类 号：R699[医药卫生—泌尿科学]