Mandhani Anil, Goyal Rajiv, Vijjan Vivek, Dubey Deepak, Kapoor Rakesh
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Urol. 2007 Sep;178(3 Pt 1):921-4. doi: 10.1016/j.juro.2007.05.021. Epub 2007 Jul 16.
We compared the outcome of tubeless percutaneous nephrolithotomy with or without Double-J(R) stent.
From January 2004 to March 2006 patients with renal stones matched for age and stone size who underwent tubeless percutaneous nephrolithotomy were prospectively evaluated in 2 groups treated by 2 surgeons. Group 1 had a Double-J stent and group 2 did not. Inclusion criteria for tubeless percutaneous nephrolithotomy included contralateral normal kidney, intact pelvicaliceal system, complete stone clearance under fluoroscopy and single infracostal puncture. These groups were compared for analgesic requirement, hospital stay, and intraoperative and postoperative complications.
During a period of 27 months 52 patients (57 renal units) underwent tubeless percutaneous nephrolithotomy. Group 1 had 25 (28 renal units) and group 2 had 27 patients (29 renal units). Mean stone volume was 4.34 +/- 2.12 cm(3) in group 1 and 4.14 +/- 1.14 cm(3) in group 2. Mean pain score was 2.96 +/- 1.24 and 2.82 +/- 0.81 in groups 1 and 2, respectively. Analgesic (intramuscular or oral diclofenac sodium) requirement and mean hospital stay was comparable in groups 1 and 2, eg 170 +/- 110 vs 163.24 +/- 98.07 mg and 2.52 +/- 0.12 vs 2.35 +/- 0.12 days. Two patients in group 1 and 1 in group 2 had urinary leak from the percutaneous nephrolithotomy tract. Similarly 3 patients in group 1 had severe stent related problems and 1 required early removal of the Double-J stent.
Avoiding use of the Double-J stent may not compromise the safety of tubeless percutaneous nephrolithotomy.
我们比较了有无双J管的无管经皮肾镜取石术的结果。
2004年1月至2006年3月，对年龄和结石大小匹配、接受无管经皮肾镜取石术的肾结石患者进行前瞻性评估，分为两组，由两位外科医生治疗。第1组置入双J管，第2组未置入。无管经皮肾镜取石术的纳入标准包括对侧肾脏正常、肾盂肾盏系统完整、透视下结石完全清除以及单肋下穿刺。比较两组的镇痛需求、住院时间以及术中及术后并发症。
在27个月期间，52例患者（57个肾单位）接受了无管经皮肾镜取石术。第1组25例（28个肾单位），第2组27例（29个肾单位）。第1组平均结石体积为4.34±2.12 cm³，第2组为4.14±1.14 cm³。第1组和第2组的平均疼痛评分分别为2.96±1.24和2.82±0.81。第1组和第2组的镇痛（肌肉注射或口服双氯芬酸钠）需求和平均住院时间相当，例如分别为170±110 vs 163.24±98.07 mg以及2.52±0.12 vs 2.35±0.12天。第1组有2例患者、第2组有1例患者出现经皮肾镜取石通道漏尿。同样，第1组有3例患者出现严重的支架相关问题，1例需要早期取出双J管。
不使用双J管可能不会影响无管经皮肾镜取石术的安全性。
