Sofer Mario, Lidawi Ghalib, Keren-Paz Gal, Yehiely Ravit, Beri Avi, Matzkin Haim
Endourology Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Isr Med Assoc J. 2010 Mar;12(3):164-7.
Tubeless percutaneous nephrolithotomy is defined as PCNL without postoperative nephrostomy tubes. It is reported to reduce postoperative pain, hospital stay and recovery time. To date the procedure has been reserved for selected patients.
To assess our initial experience in extending the implementation of tubeless PCNL without preoperative patient selection.
All consecutive PCNLs performed during 2004-2008 were evaluated. Tubeless PCNL was performed when residual stones, bleeding and extravasation were excluded intraoperatively. Staghorn stones, stone burden, supracostal and multiple accesses, anatomic anomalies, solitary kidneys and operative time were not considered contraindications. We analyzed the clinical data and the choice of tubeless PCNL over time.
Of 281 PCNLs performed during the study period 200 (71%) were tubeless. The patients' average age was 53 years (range 28-82 years), the stone burden was 924 mm2 (400-3150 mm2), operative time was 99 minutes (45-210 min), complication rate was 14% and immediate stone-free rate 91%. There were 81 conversions to standard PCNL (29%) due to expected second-look (n = 47, 58%), impression of bleeding (n = 21,26%), suspected hydrothorax (n = 7, 9%) and extravasation (n = 6, 7%). The transfusion rate was 1%. The median hospital stay was 1 day (1-15 days) and recovery time 7 days (5-20 days). The rate of implementing the tubeless procedure increased steadily along time from 46% to 83% (P = 0.0001).
Tubeless PCNL can be safely and effectively performed based on intraoperative decisions, without preoperative contraindications. They are easily accommodated by experienced endourologists and provide real advantages.
无管经皮肾镜取石术定义为术后不留置肾造瘘管的经皮肾镜取石术。据报道，该手术可减轻术后疼痛、缩短住院时间并加快恢复时间。迄今为止，该手术仅适用于特定患者。
评估我们在不进行术前患者选择的情况下扩大实施无管经皮肾镜取石术的初步经验。
对2004年至2008年期间连续进行的所有经皮肾镜取石术进行评估。术中排除残留结石、出血和外渗后进行无管经皮肾镜取石术。鹿角形结石、结石负荷、肋上及多通道入路、解剖异常、孤立肾和手术时间均不被视为禁忌证。我们分析了临床数据以及无管经皮肾镜取石术随时间的选择情况。
在研究期间进行的281例经皮肾镜取石术中，200例（71%）为无管手术。患者平均年龄53岁（范围28 - 82岁），结石负荷为924平方毫米（400 - 3150平方毫米），手术时间为99分钟（45 - 210分钟），并发症发生率为14%，即刻结石清除率为91%。因预期的二次探查（n = 47，58%）、出血迹象（n = 21，26%）、疑似胸腔积液（n = 7，9%）和外渗（n = 6，7%），有81例转为标准经皮肾镜取石术（29%）。输血率为1%。中位住院时间为1天（1 - 15天），恢复时间为7天（5 - 20天）。无管手术的实施率随时间稳步上升，从46%升至83%（P = 0.0001）。
基于术中决策，无管经皮肾镜取石术可安全有效地进行，无需术前禁忌证。经验丰富的腔内泌尿外科医生可轻松开展该手术，且其具有实际优势。
