Choi Michael, Brusky John, Weaver John, Amantia Monica, Bellman Gary C
Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California, USA.
J Endourol. 2006 Oct;20(10):766-70. doi: 10.1089/end.2006.20.766.
Recent trials using smaller percutaneous catheters as well as "tubeless" percutaneous technique have attempted to reduce postoperative analgesia requirements and the morbidity of a traditional large-bore nephrostomy tube after percutaneous nephrolithotomy (PCNL). We performed a randomized trial comparing tubeless procedures and use of small catheters to elucidate any differences in perioperative parameters, postoperative discomfort, complications, convalescence, and CT scan findings.
Twenty-four consecutive patients underwent randomization into tubeless (using a tailed 6F double-J stent) and small tube (using an 8.2 pigtail nephrostomy tube) (N = 12 each). A CT scan of the abdomen and pelvis without contrast was obtained the morning of the first postoperative day. Morphine equivalents and a visual analog pain score, as well as questionnaires for convalescence at the postoperative check, postoperative day 1, time of tube removal (3-5 days), and 1-week follow-up were recorded.
The mean pain scores and morphine requirements for the tubeless and small-tube groups at postoperative day 0, postoperative day 1, time of stent removal, and 10 days were not significantly different. Convalescence significantly favored stented patients. The CT findings were equivalent. Three patients had inadvertent dislodgment of their stents.
Tubeless and small-bore procedures cause similar postoperative discomfort, with indwelling stents appearing to quicken return to normal activities. Tailed stents may not be appropriate for all patients.
近期使用更细的经皮导管以及“无管”经皮技术的试验试图减少经皮肾镜取石术（PCNL）后术后镇痛需求以及传统大口径肾造瘘管的发病率。我们进行了一项随机试验，比较无管手术和使用细导管，以阐明围手术期参数、术后不适、并发症、康复情况及CT扫描结果的任何差异。
连续24例患者被随机分为无管组（使用带尾6F双J支架）和细管组（使用8.2猪尾肾造瘘管）（每组N = 12）。术后第一天上午进行腹部和盆腔非增强CT扫描。记录术后检查、术后第1天、拔管时（3 - 5天）及1周随访时的吗啡等效剂量、视觉模拟疼痛评分以及康复问卷。
无管组和细管组在术后第0天、术后第1天、支架取出时及10天时的平均疼痛评分和吗啡需求量无显著差异。康复情况明显有利于带支架的患者。CT检查结果相当。3例患者的支架意外移位。
无管和细口径手术引起的术后不适相似，留置支架似乎能加快恢复正常活动。带尾支架可能并非适用于所有患者。
