无管化经皮肾镜碎石取石术治疗鹿角形肾结石  

Tubeless percutaneous nephrolithotomy for the treatment of staghorn stones

作　　者：李茂胤 王德娟[1] 黄文涛[1] 胡成[1] 李科[1] 钟文文[1] 邱剑光[1] 

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2016年第1期36-39,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：广东省科技计划社会发展项目(2010B031600083)

摘　　要：目的研究无管化经皮肾镜碎石取石术(PCNL)治疗鹿角形肾结石的安全性和有效性。方法回顾性分析30例无管化PCNL治疗鹿角形肾结石病例,按照年龄、性别、体重、结石面积、Guy's stone评分和麻醉ASA分级进行配对,从我院病案数据库中选取了30例标准化PCNL治疗鹿角形肾结石病例。总结分析术后住院时间、手术时间、止痛药应用、一期结石清除率、并发症等数据。结果两组的年龄、性别、体重、结石面积、Guy's stone评分和麻醉ASA分级均无统计学差异。无管化组与标准组术后平均住院时间分别为5.5(2.3)d和9.0(5.5)d(P<0.05),手术时间分别为155(121)min和180(94)min(P<0.05)。两组间一期结石清除率、术中血红蛋白下降值、术后输血率、发热率、肾周血肿发生率、胸水发生率和止痛药使用率差异均无统计学意义。结论对于已取得较好经验的经皮肾镜手术专家,采用不留置肾造瘘管的无管化PCNL治疗鹿角形肾结石安全、有效,能缩短术后住院时间,而术后并发症的发生率与标准化PCNL比较并无明显差异,但需掌握其适应证,对术中严重出血、手术侧肾盂穿刺液为脓性,术中出现集合系统穿孔、输尿管或肾盂输尿管连接部狭窄者等禁用。Objective To evaluate efficacy and safety of tubeless percutaneous nephrolithotomy（PCNL） for the treatment of renal staghorn stones. Methods 30 patients who underwent tubeless PCNL under general anesthesia（tubeless PCNL group） were enrolled retrospectively. Patients were matched for age,sex, weight, stone size, Guy＇s stone score and American Society of Anesthesiologists（ASA） score with 30 patients who underwent conventional PCNL from our PCNL database（conventional PCNL group）.Preoperative and postoperative parameters were analyzed between the two groups, including postoperative hospital stay, operative time, analgesic requirement, stone-free clearance rate and complications. Results No significant differences in age, sex, weight, stone size, Guy＇s stone score and ASA score were observed between the two groups. Shorter operative time and postoperative hospital stay were noted in the tubeless PCNL group [155（121） vs 180（94） min（P〈0.05）, 5.5（2.3） vs 9.0（5.5） days（P〈0.05）]. In addition, there was no significant difference in stone-free clearance rate, hemoglobin decrease, blood transfusion, fever,perirenal hematoma, hydrothorax and analgesic requirements. Conclusions This study demonstrates that tubeless PCNL is a safe, efficacious, and cost-effective option in renal staghorn calculi by the wellexperienced urologist, which is associated with short hospital stay and the same morbidity as conventional PCNL. However the contraindications such as significant bleeding or perforation of the collecting system,pyonephrosis, ureteral or ureteropelvic junction stricture shoud be borne in mind.

关 键 词：无管化 肾造口术 经皮 肾结石 

分 类 号：R699.2[医药卫生—泌尿科学]