Department of Urology, Ministry of Health, Kecioren Training and Research Hospital, Ankara, Turkey.
Urology. 2010 Aug;76(2):289-93. doi: 10.1016/j.urology.2009.11.077. Epub 2010 Mar 17.
To evaluate the safety, effectiveness, and feasibility of totally (tubeless and stentless) tubeless percutaneous nephrolithotomy (PCNL) in elderly patients. Tubeless PCNL is performed widely in adult patients.
A total of 60 patients with renal stones were enrolled in this study. Patients were randomized to either a totally tubeless approach (group 1, 30 patients) or placement of an 18F nephrostomy tube (group 2, 30 patients). Patients were considered uncomplicated and suitable for randomization at the end of the operation if there was no significant bleeding or residual stone, and the pelvicaliceal system was intact. The incidence of complications, hospital stay, analgesic requirements, and stone-free rates were compared in 2 groups.
The mean age of the patients at receipt of the surgical procedure was 67.7 years (range, 60-77) vs 66.5 years (range, 61-74), respectively. The mean stone size was 25.6 vs 22.3 mm and stone-free rate was 86% vs 83% for group 1 and 2, respectively (P > .05). The mean hospitalization time was 1.5 and 3.2 days (P < .001), the mean analgesia requirement (pethidine HCl) was 0.5 and 1.4 mg/kg, respectively (P < .01). Decrease in hematocrit was similar in 2 groups. No blood transfusions were needed.
Totally tubeless PCNL is safe and effective procedure even in elderly patients with renal stones. The hospitalization and analgesic requirements are less than standard PCNL. However, the tubeless decision should be taken intraoperatively in selected patients.
评估完全（无管和无支架）无管经皮肾镜取石术（PCNL）在老年患者中的安全性、有效性和可行性。无管 PCNL 在成年患者中广泛开展。
本研究共纳入 60 例肾结石患者。患者随机分为完全无管组（第 1 组，30 例）或放置 18F 肾造瘘管组（第 2 组，30 例）。如果没有明显出血或残留结石，且肾盂肾盏系统完整，则认为患者术后无并发症且适合随机分组。比较两组患者的并发症发生率、住院时间、镇痛需求和结石清除率。
患者接受手术时的平均年龄分别为 67.7 岁（范围 60-77 岁）和 66.5 岁（范围 61-74 岁）。结石大小的平均直径分别为 25.6mm 和 22.3mm，结石清除率分别为 86%和 83%（P＞0.05）。第 1 组和第 2 组的平均住院时间分别为 1.5 天和 3.2 天（P＜0.001），平均哌替啶（盐酸）用量分别为 0.5mg/kg 和 1.4mg/kg（P＜0.01）。两组的血细胞比容下降情况相似。均未输血。
即使在老年肾结石患者中，完全无管 PCNL 也是一种安全有效的治疗方法。住院时间和镇痛需求均少于标准 PCNL。然而，该无管决策应在有选择的患者中术中做出。
