Wen Xingqiao, Gao Xin, Li Xiaojuan, Lu Minhua, Cai Yubin, Qiu Jianguang, Xiao Cuilan
Department of Urology, Sun Yat-sen University, Guangzhou, China.
J Endourol. 2007 Nov;21(11):1281-5. doi: 10.1089/end.2007.0028.
A percutaneous nephrostomy (PCN) done on the same side as a previous open nephrolithotomy is always technically challenging. A novel one-step PCN tube that allows the puncture and placement of a drainage tube to be done in a single step has been developed. The hydrophilic coating on the tube's surface significantly reduces friction and allows easier insertion. We evaluated the tube's efficiency and safety compared with the traditional fascial dilator system.
Sixty-five patients with a history of open nephrolithotomy were randomly allocated (with the aid of a computer-derived assignment number) into two groups to have PCN performed in one step or multiple steps. In the one-step group, a new type of PCN tube was used. In the multistep group, fascial dilators were used serially prior to tube insertion. The two groups were similar in terms of mean age, width of target calix, and baseline serum creatinine and hemoglobin concentrations. The operating times, intubation rates, and complications in the two groups were compared.
The mean number of attempts required to access the collecting system was 1.1 +/- 0.6 in the one-step group v 2.3 +/- 1.2 in the multistep group (P = 0.002), the successful intubation rate was 96.9% v 78.8% (P = 0.012), the mean operating time was 10.2 +/- 2.4 minutes v 25.6 +/- 2.8 minutes (P = 0.029), and the rate of intraoperative and postoperative complications was 3.1% v 15.2%, respectively (P = 0.019). No major complications occurred in the one-step group.
The one-step PCN tube is a convenient and efficacious method for accessing an anatomic region where open nephrolithotomy was done previously and is a simple method for nephrostomy tube placement.
在先前进行过开放性肾切开取石术的同一侧进行经皮肾造瘘术（PCN）在技术上一直具有挑战性。已研发出一种新型的一步式PCN管，可在一步操作中完成穿刺和引流管置入。该管表面的亲水涂层显著降低了摩擦力，使插入更容易。我们将该管与传统筋膜扩张器系统相比，评估了其有效性和安全性。
65例有开放性肾切开取石术病史的患者借助计算机生成的分配号码随机分为两组，分别接受一步法或多步法PCN。一步法组使用新型PCN管。多步法组在置入导管前依次使用筋膜扩张器。两组在平均年龄、目标肾盏宽度、基线血清肌酐和血红蛋白浓度方面相似。比较了两组的手术时间、插管成功率和并发症情况。
一步法组进入集合系统所需的平均尝试次数为1.1±0.6次，多步法组为2.3±1.2次（P = 0.002）；成功插管率分别为96.9%和78.8%（P = 0.012）；平均手术时间分别为10.2±2.4分钟和25.6±2.8分钟（P = 0.029）；术中和术后并发症发生率分别为3.1%和15.2%（P = 0.019）。一步法组未发生重大并发症。
一步式PCN管是进入先前进行过开放性肾切开取石术的解剖区域的一种方便且有效的方法，也是一种简单的肾造瘘管置入方法。
