无管微创经皮肾镜取石术临床评价

目的 评价微创经皮肾镜取石(MPCNL)术后不放置肾造瘘管的可行性. 方法 选择MPCNL后符合单通道、无集合系统穿孔、B超无明显结石残留,无明显出血患者40例,碎石操作结束后随机分成2组.留置肾造瘘管组(A组)20例,其中肾内结石16例,输尿管上段结石4例,结石直径1.3～8.6 cm,平均3.4 cm.不留置造瘘管组(B组)20例.其中肾结石14例,输尿管上段结石6例,结石直径1.1～7.9 cm,平均3.1 cm.2组均留置6 F双J管.比较2组患者术后Hb下降幅度、疼痛不适及并发症发生情况. 结果 2组结石直径比较差异无统计学意义(P=0.23).2组手术时间分别为(98±29)和(92±31)min(P=0.63),术后Hb下降幅度为(3.3±1.6)%和(3.1±1.6)%(P=0.49).术后疼痛评分采用视觉模拟评分,2组术后第1天分别为3.6±1.8和3.3±1.5(P=0.66)、术后第3天为1.6±1.2和1.8±1.3(P=0.62).2组各有1例术后出现发热,B组出现1例穿刺通道周围血肿.2组均未输血,术后均未发生肾绞痛. 结论 选择符合特定条件者不放置肾造瘘管行MPCNL是安全的.

Safety of tubeless micro-percutaneous nephrolithotomy

Objective To evaluate the safety of tubeless micro-percutaneous nephrolithotomy (MPCNL). Methods Forty patients who met the criteria(single percutaneous tract, no serious bleeding or perforation in the collecting system and absence of insignificant residual fragments under B-US)were included. After the operation of stone fragmentation, all patients were randomly divided into 2 groups. Twenty patients underwent standard MPCNL(group A), 16 eases had stones in kidney and 4 in upper ureter. Longitudinal sizes of calculi were 1.3-8. 6 era(mean 3.4 era). Twenty patients in group B were with tubeless procedures, 14 patients had stones in kidney and 6 in upper ureter. Longi-tudinal sizes of calculi were 1.1-7. 9 era(mean 3.1 era). Double J stents were placed in all eases. Changes of hemoglobins, pain and complications were recorded and ststistieally analyzed. Results There were no differences in stone size(P=0. 23), operation time (98±29 rain vs 92±31 min, P=0. 63) between the 2 groups. The changes of hemoglobin had no significant difference between 2 groups[(3.3±1.6)% vs (3.1±1.6)%, P=0. 49]. Postoperative pain was assessed using a visual analog scale. The scores of both groups on the first postoperative day were 3.6±1.8(group A) and 3.3±1.5(group B,P=0. 66). On the third day the scores were 1.6±1.2 and 1.8±1.3(P=0. 62). Both groups had 1 patient suffered from mild fever. No transfuaion was performed and no renal colic happened in 2 groups. Conclustion Under certain circumstance, tubeless MPCNL is a safe procedure for patients with urolithiasis.