Crook T J, Lockyer C R, Keoghane S R, Walmsley B H
Solent Department of Urology, St. Mary's Hospital, Portsmouth, United Kingdom.
J Urol. 2008 Aug;180(2):612-4. doi: 10.1016/j.juro.2008.04.020. Epub 2008 Jun 12.
We established whether totally tubeless percutaneous nephrolithotomy with no nephrostomy or ureteral stent is a safe management technique.
Patients were randomized to have a nephrostomy placed (group 1 control) or none (group 2 treatment). A total of 25 patients were randomized to each group. Cases were considered uncomplicated and suitable for randomization if there was no significant bleeding or residual stone load, the pelvicaliceal system was intact and there was no evidence of a residual ureteral stone. The primary outcome measure was length of stay, and secondary outcomes were analgesic requirements and postoperative complications such as bleeding, infection or ureteral obstruction. Hospital readmission rates and stone clearance rates were also recorded.
Mean stone size was 21.6 vs 17.5 mm. There were no transfusions in either group. Hemoglobin change was 2.03 vs 1.18 gm/dl and mean creatinine increase was 0.029 vs -0.111 mg/dl. There were no differences in hemorrhage, infection and serum parameters. There were no readmissions in either group. Mean length of stay was 3.4 vs 2.3 days (p <0.05).
This trial demonstrates that percutaneous nephrolithotomy without nephrostomy or stent is a safe and well tolerated procedure in selected patients. Length of stay was reduced with no major complications in either group. We believe that totally tubeless percutaneous nephrolithotomy may be considered an accepted standard of care for selected cases and it is possible to reserve placement of a nephrostomy tube or internal ureteral stent for specific indications.
我们确定了不放置肾造瘘管或输尿管支架的完全无管经皮肾镜取石术是否为一种安全的治疗技术。
将患者随机分为放置肾造瘘管组（第1组，对照组）或不放置肾造瘘管组（第2组，治疗组）。每组随机分配25例患者。如果没有明显出血或残余结石负荷、肾盂肾盏系统完整且没有残余输尿管结石的证据，则病例被认为是无并发症且适合随机分组。主要观察指标为住院时间，次要观察指标为镇痛需求以及术后并发症，如出血、感染或输尿管梗阻。还记录了医院再入院率和结石清除率。
平均结石大小分别为21.6和17.5毫米。两组均无输血情况。血红蛋白变化分别为2.03和1.18克/分升，平均肌酐升高分别为0.029和 -0.111毫克/分升。出血、感染和血清参数方面无差异。两组均无再次入院情况。平均住院时间分别为3.4天和2.3天（p<0.05）。
本试验表明，对于选定的患者，不放置肾造瘘管或支架的经皮肾镜取石术是一种安全且耐受性良好的手术。两组住院时间均缩短，且无重大并发症。我们认为，对于选定的病例，完全无管经皮肾镜取石术可被视为一种可接受的治疗标准，并且有可能针对特定指征保留肾造瘘管或输尿管内支架的放置。
