微创经皮肾镜取石术后留置气囊造瘘管和普通硅胶管的对比研究

目的：探讨留置气囊造瘘管和普通硅胶管两种不同造瘘管对微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotomy,mPCNL）的影响。方法：2012年3月～2012年6月将109例符合筛选条件的需要行mPCNI。处理的上尿路结石患者随机分为气囊造瘘管组（A组）和普通硅胶管组（B组），A组58例，B组51例。观察两组患者一般情况、术前术后和拔管前血红蛋白、肾功能、中段尿培养、结石负荷、术中手术时间、术后尿外渗、造瘘管脱落、术后出血、全身炎症反应综合征（systemic inflammatory response syndrome, SIRS）、留置造瘘管时间内平均每天的视觉疼痛评分（visual analogue scale, VAS）、平均术后血红蛋白变化、输血情况及介人情况。结果：两组患者在术后出血、介入、术后发生SIRS、造瘘管留置时间、平均每天VAS评分、超过12小时的尿瘘方面差异无统计学意义（P〉0．05）。在术后平均血红蛋白变化上，术后1天和2天，A组变化小于B组，A组输血率明显低于B组，差异均有统计学意义（P〈0．05）。A组的平均住院费用低于B组。结论：mPCNL后留置气囊造瘘管可能是一种比较全面、安全和保险的选择。在保证引流的情况下，可以减少术后的输血和住院费用，降低造瘘管脱落风险，且并不增加患者术后的不适和SIRS的发生。

Comparison between indwelling balloon and silicon nephrostomy tube after minimally invasive percutaneous nephrolithotomy

Objective：To investigate the difference of indwelling balloon or silicon nephrostomy tube after minimally invasive percutaneous nephrolithotomy （mPCNL）. Method： From Mar 2012 to Jun 2012 three hundred and twenty one patients were randomized into two groups （Group A： balloon, Group B： silicon）. The final patients in group were those who were inserted F16 nephrostomy tube without internal medical complication, by only undergo ing one stage single tract mPCNL. The data collected included preoperative hemoglobin value, urine culture, stone burden, operative duration, blood transfusion, systemic inflammatory response syndrome（SIRS）, mean visual analogue scale （VAS） per day and loss ratio of the tube. In addition, the change of hemoglobin between preoperation and immediate, 1 day or 2 days postoperation were recorded. Result： One hundred and nine cases included 58 in Group A and 51 in Group B. There were no significant differences between the two groups in terms of hemor rhage, SIRS, VAS, and duration of tube. In the aspects of change of hemoglobin between preoperation and 1 day or 2 days postoperation, there were significant differences between two groups. Group A had lower blood transfu- sion rate and mean hospital cost than Group B. Conclusion： Indwelling balloon nephrostomy tube after mPCNL could not only maintain well drainage, but also reduce blood loss 1 day or 2 days postoperation, the incidence of Furthermore, it did not lead to the development of SIRS and pain.