基于倾向性评分匹配的输尿管外支架管和双J管在无管化经皮肾镜取石术中的疗效比较*

目的比较输尿管外支架管与双J管在无管化经皮肾镜取石术(PCNL)中应用的安全性及有效性。方法选择2016年1月-2018年2月由笔者主刀实施无管化PCNL的105例患者的临床资料,采用倾向性评分匹配法(PSM),选取输尿管外支架管组与双J管组各30例进行安全性及有效性比较,比较两组患者手术时间、术后住院时间、术后1 d结石清除率、术后3个月结石清除率、内支架管相关性不适、术后疼痛评分、镇痛药物的需求及术后并发症的发生率等指标的区别。结果 60例患者手术均一期顺利完成,两组术后住院时间、术后1 d结石清除率、术后3个月结石清除率、术后疼痛评分、镇痛药物的需求及术后并发症的发生率比较,差异均无统计学意义(P0.05),两组的手术时间分别为(45.32±27.78)和(67.51±30.53)min、支架管相关性不适的发生率分别为0.0%和43.3%,差异有统计学意义(P 0.05)。结论无管化PCNL术后短暂留置输尿管外支架管是安全有效的,与双J管相比,并不增加术后相关并发症的风险,相反它可以减少手术时间,不需第二次内镜手术拔除内支架管,减少了内支架管相关性不适,改善了患者的就医体验,节约了医疗成本,有一定的临床应用价值,值得推广应用。

Comparison of externalized ureteral catheter and double-J stent in tubeless percutaneous nephrolithotomy: a propensity score matching analysis*

Abstract: Objective To compare the efficacy and safety of externalized ureteral catheter (EUC) and double-J stent (DJS) in tubeless percutaneous nephrolithotomy (PCNL) for patients with upper urinary stones. Methods The clinical data of 105 patients undergoing percutaneous nephrolithotomy is implemented by the author from January 2016 to February 2018 were selected. EUC group (30 cases) and DJS group (30 cases) were selected by a propensity score matching analysis method. And the safety and efficacy of EUC group and DJS group were compared with each other. The difference of operation times, hospitalization times, stone free rate (SFR) on the first day, SFR at the third month after operation, stent-related symptoms, pain score (VAS), analgesic required and postoperative complications were compared between the two groups. Results No significant differences were found in hospitalization times, SFR on the first day, SFR at the third month after operation, pain score (VAS), analgesic required and postoperative complications. Significantly shorter operation times was needed by EUC group than the DJS group. And the stent-related symptoms were higher for DJS compared with EUC. Conclusion EUC in tubeless PCNL is also an effective alternative for patients with upper urinary stones. Compared with DJS, it did not increase the risk of postoperative complications. On the contrary, it could reduce the operation times and stent-related discomfort. And it could avoid cystoscopy for DJS removal. It could improve the patient''s experience of medical treatment, reduce the costs. Those are likely to translate into clinical significance.