Al-Ba'adani Tawfik H, Al-Kohlany Khaled M, Al-Adimi Abdulelah, Al-Towaity Mansour, Al-Baadani Taher, Alwan Mohammed, Al-Hussieni Mohammed, Al-Germozi Shehab, Al-Masani Mokhtar, Al-Badwy Khalid, El-Nono Ibrahiem H
Urology Department, Urology and Nephrology Center, Al-Thawra Modern General Teaching Hospital, Medical College-Sana'a University, P.O. Box 18682 Sana'a, Yemen.
Int Urol Nephrol. 2008;40(3):603-8. doi: 10.1007/s11255-007-9305-8. Epub 2007 Dec 19.
We present our experience with tubeless percutaneous nephrolithotomy (PCNL).
Between July 2004 and December 2006, 121 patients (82 males and 39 females) with 18-70 mm (mean 31.19 mm) renal stones underwent tubeless PCNL leaving only a 6 Fr externalized ureteric catheter. Their ages ranged between 4 and 80 years (mean 37.27). Two patients had bilateral disease, so a total of 123 renal units are included. The procedure was performed under general anesthesia in the prone (110 units) or supine position (13 units). A total of 133 punctures were performed. The punctures were single (114 units), double (8 units), or triple (1 unit). The approach was subcostal through the lower calyx (n=110) or middle calyx (n=10), or supracostal through the middle calyx (n=8) or upper calyx (n=5).
Mean operative time was 46.30 min (range 15-100). Mean reduction in hemoglobin level was 1.57 g (range 0.3-4) with blood transfusion rate 4.13%. Complication rate was 9.9% in the form of perirenal collection (five patients), urinary leakage (two patients), fever (four patients), and hydrothorax (one patient). The ureteric catheter was left for 7-72 h (mean 45.67). Postoperative analgesia was required in 22 patients (18.2%) with mean 22.9 mg diclofenac sodium per patient. Mean hospital stay was 50.69 h (range 12-96) with 106 units (86.18%) rendered stone free, 13 (10.57%) with insignificant residuals, and four units (3.25%) were left with significant residual stones.
Tubeless PCNL is a good option in non-complicated PCNL with the advantages of reduced hospital stay, low postoperative pain, and little need for postoperative analgesia.
介绍我们开展无管经皮肾镜取石术（PCNL）的经验。
2004年7月至2006年12月期间，121例（82例男性，39例女性）肾结石直径为18 - 70mm（平均31.19mm）的患者接受了无管PCNL手术，术后仅留置一根6F的外置输尿管导管。他们的年龄在4至80岁之间（平均37.27岁）。2例患者为双侧病变，因此共纳入123个肾单位。手术采用全身麻醉，患者取俯卧位（110个肾单位）或仰卧位（13个肾单位）。总共进行了133次穿刺。穿刺方式为单次（114个肾单位）、两次（8个肾单位）或三次（1个肾单位）。穿刺路径为经肋下通过下盏（n = 110）或中盏（n = 10），或经肋上通过中盏（n = 8）或上盏（n = 5）。
平均手术时间为46.3分钟（范围15 - 100分钟）。血红蛋白水平平均下降1.57g（范围0.3 - 4g），输血率为4.13%。并发症发生率为9.9%，表现为肾周积液（5例患者）、尿漏（2例患者）、发热（4例患者）和气胸（1例患者）。输尿管导管留置7 - 72小时（平均45.67小时）。22例患者（18.2%）需要术后镇痛，每位患者平均使用22.9mg双氯芬酸钠。平均住院时间为50.69小时（范围12 - 96小时），106个肾单位（86.18%）结石清除，13个肾单位（10.57%）残留结石不明显，4个肾单位（3.25%）残留结石明显。
对于非复杂性PCNL，无管PCNL是一个不错的选择，具有缩短住院时间、术后疼痛轻和术后镇痛需求少等优点。
