Mokhmalji H, Braun P M, Martinez Portillo F J, Siegsmund M, Alken P, Köhrmann K U
Department of Urology, University Hospital Mannheim, Mannheim, Germany.
J Urol. 2001 Apr;165(4):1088-92.
Urinary diversion with percutaneous nephrostomy or ureteral stent is indicated by symptoms, such as persistent colic, high temperature and uremia, of hydronephrosis caused by stones. We evaluate which of these 2 methods is superior concerning the course of procedure, relief of accompanying symptoms and quality of life in regard to patient age and sex.
A total of 40 patients with stone induced hydronephrosis were randomized into either percutaneous nephrostomy or stent insertion groups. These patients were then evaluated by procedure (use of analgesics, x-ray exposure, success of insertion), relief of accompanying symptoms (duration of diversion, intravenous administration of antibiotics for high temperature) and quality of life (questionnaire immediately and 2 to 4 weeks postoperatively).
Two comparable groups of patients were formed, with an average age of 55 versus 49 years and a male-to-female ratio of 12:8 versus 9:11 for those who underwent percutaneous nephrostomy versus those who received a stent, respectively. Percutaneous nephrostomy was successfully completed in 100% of patients and stents were successful in 80%, with a 20% conversion to percutaneous nephrostomy. The x-ray exposure was shorter in the percutaneous nephrostomy group (p = 0.052). Administration of analgesics was more frequent in the stent group (p = 0.061). Percutaneous nephrostomy indwelling time was shorter (50% less than 2 weeks) than that of stents (25% less than 2 weeks, p = 0.043). Antibiotics were administered for greater than 5 days in 0% of patients who underwent percutaneous nephrostomy versus 64% in those with stents (p = 0.174). Reduction in quality of life was moderate but more pronounced in patients with stents compared to those who underwent percutaneous nephrostomy, and was more distinct in males and younger patients. The quality of life progressively improved in the course of diversion with percutaneous nephrostomy but deteriorated with stents.
Our results demonstrated that percutaneous nephrostomy is superior to ureteral stents for diversion of hydronephrosis caused by stones, especially in patients with a high temperature, as well as in males and juveniles.
经皮肾造瘘术或输尿管支架置入术用于因结石导致肾积水出现持续绞痛、高热及尿毒症等症状时的尿液转流。我们评估这两种方法在手术过程、伴随症状缓解及患者年龄和性别相关的生活质量方面哪种更具优势。
总共40例结石性肾积水患者被随机分为经皮肾造瘘术组或支架置入组。然后对这些患者进行手术评估（镇痛药使用情况、X线暴露情况、置入成功率）、伴随症状缓解情况（转流持续时间、因高热静脉使用抗生素情况）及生活质量评估（术后即刻及术后2至4周问卷调查）。
形成了两组具有可比性的患者，经皮肾造瘘术组患者平均年龄55岁，支架置入组平均年龄49岁；经皮肾造瘘术组男女比例为12:8，支架置入组男女比例为9:11。经皮肾造瘘术在100%的患者中成功完成，支架置入成功率为80%，有20%的患者转为经皮肾造瘘术。经皮肾造瘘术组X线暴露时间更短（p = 0.052）。支架置入组镇痛药使用更频繁（p = 0.061）。经皮肾造瘘管留置时间更短（50%少于2周），而支架留置时间（25%少于2周，p = 0.043）。经皮肾造瘘术患者中0%使用抗生素超过５天，而支架置入患者中64%使用抗生素超过５天（p = 0.174）。生活质量下降程度中等，但与经皮肾造瘘术患者相比，支架置入患者更明显，且在男性和年轻患者中更显著。经皮肾造瘘术转流过程中生活质量逐渐改善，而支架置入则使其恶化。
我们的结果表明，对于结石性肾积水的尿液转流，经皮肾造瘘术优于输尿管支架置入术，尤其对于高热患者以及男性和青少年患者。
