[1]高小峰,陈书尚,孙颖浩,等.经皮肾取石术后不留置肾造瘘管的适应证和安全性[J].中国微创外科杂志,2009,09(9):793-795.
　Gao Xiaofeng,Chen Shushang,Sun Yinghao,et al.Indications and Safety of Tubeless Percutaneous Nephrostolithotomy[J].Chinese Journal of Minimally Invasive Surgery,2009,09(9):793-795.
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经皮肾取石术后不留置肾造瘘管的适应证和安全性()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
09
期数:
2009年9期
页码:
793-795
栏目:
出版日期:
2009-09-30

文章信息/Info

Title:
Indications and Safety of Tubeless Percutaneous Nephrostolithotomy
作者:
高小峰; 陈书尚; 孙颖浩; 周铁; 王林辉; 许传亮; 高旭; 侯建国
第二军医大学长海医院泌尿外科，上海200433
Author(s):
Gao Xiaofeng;  Chen Shushang;  Sun Yinghao;  et al．
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
关键词:
肾结石; 输尿管上段结石; 经皮肾取石术; 肾造瘘管
Keywords:
Renal stone; Percutaneous nephrolithotomy;  Nephrostomy drainage
分类号:
R692.4
文献标志码:
A
摘要:
目的探讨经皮肾取石术(percutaneous nephrolithotomy,PCNL)后不留置肾造瘘管的适应证和安全性。方法根据PCNL术前、术中情况选择合适病例。入选标准：术前B超报告肾盂积水<4 cm，血清肌酐值正常；单一穿刺通道；术前、术中无尿路感染征象；术中无出血，集合系统无大面积穿孔；无结石残留，或虽有小结石残留但不需要行二次经皮肾手术者；术中顺利置入双J管；手术时间<2 h。共入选240例输尿管上段及肾结石，按手术次序的奇偶数分为2组（各120例）：A组术后不放置肾盂造瘘管，B组术后放置F14肾盂造瘘管。结果240例均一期手术成功。2组结石清除率分别为98.3％（118/120）和96.7％（116/120），二者相比无统计学差异（χ2=0.171，P=0.679）。2组术中、术后均无输血病例；术后18例发热（A组8例，B组10例， χ2=0.240，P=0.624），均无感染性休克。术后48 h B超检查2组患者均未见肾周积液。结论对于经过严格选择的患者，经皮肾取石术后不放置肾盂造瘘管安全而有效。
Abstract:
ObjectiveTo explore indications and safety of tubeless percutaneous nephrolithotomy (PCNL).MethodsPatients were enrolled into this study at the end of PCNL according to their pre and intraoperative conditions. The inclusion criteria included：the degree of nephrohydrosis by preoperative Bultrasonography less than 4 cm；preoperative level of serum creatinine is normal; single percutaneous tract; no sign of urinary infection before and during operation; no obvious operative bleeding or severe collecting system perforation; no residual stone or with small residual stone but no need for second percutaneous operation; operation time for PNCL less than 2 hours (doubleJ tube placement was placed successfully). A total of 240 patients with upper ureteral calculi or renal stones were selected and randomly allocated to no nephrostomy drainage (Group A, 120 patients) or standard (F14) nephrostomy drainage (Group B, 120 patients) groups according to the parity of the patients’ number. ResultsPCNL was completed successfully in both the groups with a high rate of stone clearance ［98.3% (118/120) vs 96.7% (116/120), χ2=0.171, P=0.679］. No patient required blood transfusion. After the operation, 18 patients showed fever but without infectious shock (Group A: 8 vs Group B: 10, χ2=0.240, P=0.624). No perinephric fluidity was observed by Bultrasonography either in Group A or Group B in 48 hours after the surgery.ConclusionsAs for strictly selected patients, tubeless PCNL is a safe and effective treatment.

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更新日期/Last Update: 2014-01-08