CAJ | 학술논문

目的通过随机对照临床试验,研究无管化PCNL的可行性、安全件和疗效. 方法 2010年5-8月行PCNL患者,术中取石完毕,随机数字法将患者随机分为试验组(无管化PCNL,即只留置双J管,不留置肾造瘘管)与对照组(传统PCNL,留置双J管及肾造瘘管).排除标准:严重出血需输血者；明显结石残留需行二期碎石取石i者；重度肾积水,肾实质厚度＜5 mm者；肾盂穿刺液为脓件者；合并输尿管狭窄或肾盂输尿管连接处狭窄；集合系统严重穿孔者.共50例患者被纳入研究,试验组和对照组各25例,两组患者的年龄、性别、结石大小差异均正统计学意义(P＞0.05).所有手术均由一位医生主刀.评价指标包括术后疼痛、Hb下降量、输血率、发热发生率、肾周血肿发生率、住院时间等. 结果术后第1天试验组疼痛视觉模拟评分(VAS)为2.24,对照组为5.04(P＜0.01)；试验组术后平均住院时间3.04 d,对照组6.88 d,两组差异有统计学意义(P＜0.01)；两组术后Hb下降量、结石清除率差异无统计学意义(P＞0.05).两组输血率(1/25与3/25,P＞0.05)、肾周血肿发生率(6/27与7/27,P＞0.05)、发热发生率(3/25与4/25,P＞0.05)比较差异亦无统计学意义.两组患者术后穿刺通道部位均无漏尿发生. 结论无管化PCNL安全,能显著减轻患者术后疼痛不适,缩短住院时间,且不增加出血、漏尿等并发症发生率,但需恰当掌握其适应证,对术中大出血、肾积脓、输尿管梗阻、集合系统严重穿孔、结石残留需二期手术者禁用.
목적 통과수궤대조림상시험,연구무관화PCNL적가행성、안전건화료효. 방법 2010년5-8월행PCNL환자,술중취석완필,수궤수자법장환자수궤분위시험조(무관화PCNL,즉지류치쌍J관,불류치신조루관)여대조조(전통PCNL,류치쌍J관급신조루관).배제표준:엄중출혈수수혈자；명현결석잔류수행이기쇄석취석i자；중도신적수,신실질후도＜5 mm자；신우천자액위농건자；합병수뇨관협착혹신우수뇨관련접처협착；집합계통엄중천공자.공50례환자피납입연구,시험조화대조조각25례,량조환자적년령、성별、결석대소차이균정통계학의의(P＞0.05).소유수술균유일위의생주도.평개지표포괄술후동통、Hb하강량、수혈솔、발열발생솔、신주혈종발생솔、주원시간등. 결과 술후제1천시험조동통시각모의평분(VAS)위2.24,대조조위5.04(P＜0.01)；시험조술후평균주원시간3.04 d,대조조6.88 d,량조차이유통계학의의(P＜0.01)；량조술후Hb하강량、결석청제솔차이무통계학의의(P＞0.05).량조수혈솔(1/25여3/25,P＞0.05)、신주혈종발생솔(6/27여7/27,P＞0.05)、발열발생솔(3/25여4/25,P＞0.05)비교차이역무통계학의의.량조환자술후천자통도부위균무루뇨발생. 결론 무관화PCNL안전,능현저감경환자술후동통불괄,축단주원시간,차불증가출혈、루뇨등병발증발생솔,단수흡당장악기괄응증,대술중대출혈、신적농、수뇨관경조、집합계통엄중천공、결석잔류수이기수술자금용.
Objective To evaluate the feasibility,safety and efficacy of tubeless percutaneous nephrolithotomy ( PCNL).Methods Patients who underwent PCNL were randomized into 2 groups by extracting a random number generated from random number table,tubeless PCNL group and traditional PCNL group when the stones were cleared.Each patient in tubeless PCNL group was treated with insertion of a F5 ureteral double pigtail stent without placement of nephrostomy tube,while both double pigtail stent and F16 nephrostomy tube were placed in patients in traditional PCNL group.Exclusion criteria were severe bleeding requiring blood transfusion,stone residual requring a second PCNL,severe hydronephrosis with the thickness of renal parenchyma less than 5 mm,pyonephrosis,stricture of ureter or ureteropelvic junction,and severe perforation of the collecting system.A total of 50 patients were enrolled in this study.Tubeless PCNL and traditional PNCL were performed in 25 patients,including 27 kidney units,respectively.The two groups had comparable demographic data.All the operations were performed by the same surgeon.Evaluation factors included postoperative pain,decreased hemoglobin,blood transfusion rate,incidence of fever and perirenal hematoma,and duration of hospitalization.Results The average visual analogue scale (VAS) score on postoperative day 1 in tubeless PCNL group was 2.24 compared with 5.04 in traditional PCNL group (P ＜ 0.01 ).The average hospital stay in tubeless PC NL group (3.04 d) was significantly shorter than that in traditioal PCNL group (6.88 d) (P ＜0.01 ).The differences in average hemoglobin drop and stone clearance in the 2 groups were not significant.The differences between the 2 groups in blood transfusion ( 1/25 in tubeless PCNL group vs 3/25 in traditional PCNL group,P ＞0.05),renal hematomas rate (6/27 in tubeless PCNL group vs 7/27 in traditional PCNL group,P ＞ 0.05) and fever rate (3/25 in tubeless PCNL group vs 4/25 in traditional PCNL group,P ＞0.05 ) were not significant.There was no incidence of urinary leakage from the nephrostomy site in the 2 groups.Conclusions Tubeless PCNL can significantly decrease postoperative pain and discomfort and shorten the duration of hospitalization without increase of complications.Tubeless PCNL is safe,effective and performable,but the contraindications such as massive haemorrhage,pyonephrosis,ureteral obstruction,severe perforation of the collecting system,residual stone requring a second PCNL,should be kept in mind.