新型末端纤柔型经皮肾造瘘引流管的设计与临床应用

目的介绍一种专用于经皮肾镜取石术(PCNL)的末端纤柔的肾造瘘引流管,初步探讨其应用于PCNL的可行性。方法回顾分析2018年3月至2018年10月南方医科大学珠江医院收治的100例行PCNL的患者资料,术中使用本新型管道者50例,设为新型管道组,其余50例患者术中留置常规肾造瘘管,设为常规管道组。分析比较2组患者携带造瘘管及尿管的时长、住院时长、拔管过程中及拔管后出血情况等指标;验证新型管道组拔管后再次插入的成功率。结果新型管道组与常规管道组比较留置造瘘管的时长[(21.13±2.12)h vs.(55.67±18.52)h]、留置尿管时长[(40.40±4.75)h vs.(73.34±20.12)h]、住院时间[(48.48±3.39)h vs.(87.36±21.55)h]、术后第1天视觉模拟评分法(VAS)评分[(3.08±1.00)分vs.(4.76±1.41)分]、拔管后出血病例血红蛋白(△Hb)[(4.60±1.14)g/L vs.(20.00±2.83)g/L]均明显低于常规管道组(P<0.05)。2组术后腹膜后血肿发生率及一期碎石率差异无统计学意义(P>0.05);新型管道组拔管后再次插入的成功率为100%。结论在经皮肾镜取石术中使用末端纤柔型肾造瘘管,可以减少住院时间,减轻患者携带造瘘管相关不适,提高医疗安全性,值得进一步临床探讨和研究。

Design and clinical application of a novel nephrostomy tube with a flexible tail

Objective To introduce a novel nephrostomy tube with a flexible tail and to explore the feasibility of using it in percutaneous nephrolithotomy(PCNL).Method The clinical data of 100 patients who received PCNL during Mar.and Oct.2018 in our hospital were retrospectively analyzed.The patients were divided into novel tube group(n=50)and standard tube group(n=50).The indwelling time of nephrostomy tube and urinary tube,hospitalization time,bleeding and other parameters were compared between the two groups,and the success rate of reinserting tube in novel tube group was verified.Result In novel tube group and standard tube group,the indwelling time of nephrostomy tube was[(21.13±2.12)h vs.(55.67±18.52)h],indwelling time of urinary tube was[(40.40±4.75)h vs.(73.34±20.12)h],hospitalization time was[(48.48±3.39)h vs.(87.36±21.55)h],day-1 VAS score was[(3.08±1.00)vs.(4.76±1.41)],the hemoglobin reduction in bleeding cases after the nephrostomy tube was removed(△Hb)was[(4.60±1.14)g/L vs.(20.00±2.83)g/L],and there were statistical differences(all P<0.05).There were no statistical differences in stone clearance rate and incidence of retroperitoneal hematoma between the two groups(P>0.05).In the novel tube group,the success rate of reinserting tube was 100%.Conclusion Using the novel nephrostomy tube with a flexible tail in PCNL can shorten hospitalization time,reduce patientsdiscomfort and improve medical safety.It is worth of further clinical exploration and research.