Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA.
J Endourol. 2010 Sep;24(9):1427-30. doi: 10.1089/end.2010.0173.
After percutaneous nephrolithotomy (PCNL), the current standard of care is to obtain a nephrostogram before removal of the nephrostomy tube to rule out distal ureteral obstruction. The aim of this study was to determine whether nephrostogram findings predict prolonged urinary drainage and postoperative ureteral stent insertion.
Data for all patients who had nephrostomy tubes inserted post-PCNL between January and December 2006 were retrospectively reviewed. Patients with radiolucent stones, concomitant procedures, or caliceal diverticula were excluded. All nephrostograms were reviewed to identify distal ureteral obstruction without evidence of residual fragments. The Fisher's exact test was used.
Fifty patients who underwent 51 PCNLs were included in the study (one patient had bilateral PCNLs). Nephrostograms were performed on median postoperative day (POD) 2 (range POD 2-8), and tubes were removed on median POD 2 (range POD 2-10). In 14 (27%) patients who had distal ureteral obstruction without ureteral stones, the nephrostomy tube was removed on the same day of nephrostography. Eight (16%) patients experienced a prolonged urinary leak (>24 hours). While obstruction on the nephrostogram predicted prolonged urinary leak (36% vs 8%; P = 0.02), none of these obstructed patients needed postoperative ureteral stent placement. A patient with a horseshoe kidney without distal ureteral obstruction had his nephrostomy removed on POD 2. He presented on POD 7 with prolonged urinary leakage and needed readmission with ureteral stent placement and Foley catheterization.
While distal obstruction seems to predict prolonged urinary leakage (more than 24 hours), it may not necessitate ureteral stent placement or prolonged nephrostomy drainage because blood clot or ureterovesical junction edema resolve spontaneously with expectant management.
经皮肾镜碎石取石术（PCNL）后，目前的标准护理是在取出肾造瘘管前获取尿路造影以排除远端输尿管梗阻。本研究旨在确定尿路造影结果是否可以预测尿液引流时间延长和术后输尿管支架置入。
回顾性分析 2006 年 1 月至 12 月期间所有接受 PCNL 后插入肾造瘘管的患者的数据。排除了透光结石、同时进行的手术或肾盂憩室的患者。所有尿路造影均用于识别无残留碎片的远端输尿管梗阻。使用 Fisher 精确检验。
研究共纳入 50 例 51 次 PCNL 患者（1 例患者行双侧 PCNL）。尿路造影于术后第 2 天（范围第 2-8 天）进行，肾造瘘管于术后第 2 天（范围第 2-10 天）取出。在 14 例（27%）无输尿管结石但存在远端输尿管梗阻的患者中，当天即可取出肾造瘘管。8 例（16%）患者发生尿液漏出时间延长（>24 小时）。尽管尿路造影上的梗阻预测尿液漏出时间延长（36%比 8%；P=0.02），但这些梗阻患者中没有一人需要术后输尿管支架置入。1 例马蹄肾患者无远端输尿管梗阻，其肾造瘘管于第 2 天取出。他在第 7 天出现尿液漏出时间延长，需要再次入院并进行输尿管支架置入和 Foley 导管留置。
尽管远端梗阻似乎预测尿液漏出时间延长（超过 24 小时），但这可能不需要输尿管支架置入或延长肾造瘘引流，因为血液凝块或输尿管膀胱连接部水肿可通过保守治疗自行缓解。
