Comprehensive Kidney Stone Center, Division of Urology, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Urol. 2010 Oct;184(4):1261-6. doi: 10.1016/j.juro.2010.06.020. Epub 2010 Aug 17.
Traditionally the placement of a nephrostomy tube at the conclusion of percutaneous nephrolithotomy is considered the standard of care. However, the need for nephrostomy tube placement has been questioned by numerous authors. We evaluated the literature regarding tubeless percutaneous nephrolithotomy, and determined potential candidates for tubeless percutaneous nephrolithotomy and whether this procedure can be considered the new standard of care for complex stone removal.
A MEDLINE search was conducted between May 1997 and January 2010 to detect studies reporting tubeless percutaneous nephrolithotomy. "Nephrolithiasis," "percutaneous nephrolithotomy," "tubeless" and "lithotripsy" were used as medical subject headings (MeSH) key words. Additional citations were identified by reviewing the reference lists of the included articles. All relevant articles were reviewed for indications, outcomes and complications.
The data obtained from 50 reports document comparable complication rates between tubeless and standard percutaneous nephrolithotomy. Tubeless percutaneous nephrolithotomy demonstrated advantages such as less pain, less debilitation, less costs and a shorter hospital stay. Mean stone-free rates for tubeless percutaneous nephrolithotomy were as high as 89%.
Tubeless percutaneous nephrolithotomy appears to be safe and efficacious in uneventful procedures, in children, in obese patients, in simultaneous bilateral procedures, in supracostal access and in renal units with coexisting anatomical anomalies. Nephrostomy tube placement should still be considered in certain cases such as those with more than 2 nephrostomy access tracts, those necessitating a second look and those with intraoperative complications such as significant bleeding or collecting system perforation.
传统上，经皮肾镜碎石取石术（PCNL）结束时放置肾造瘘管被认为是标准的护理方法。然而，许多作者对放置肾造瘘管的必要性提出了质疑。我们评估了关于无管经皮肾镜碎石取石术的文献，并确定了无管经皮肾镜碎石取石术的潜在候选人群，以及该手术是否可以被视为复杂结石清除的新标准。
1997 年 5 月至 2010 年 1 月，我们进行了 MEDLINE 检索，以检测报道无管经皮肾镜碎石取石术的研究。使用“肾结石”、“经皮肾镜碎石取石术”、“无管”和“碎石术”作为医学主题词（MeSH）关键词。通过查看纳入文章的参考文献列表，确定了其他引文。对所有相关文章的适应证、结果和并发症进行了评估。
从 50 份报告中获得的数据表明，无管和标准经皮肾镜碎石取石术的并发症发生率相似。无管经皮肾镜碎石取石术具有疼痛减轻、体力消耗减少、费用降低和住院时间缩短等优势。无管经皮肾镜碎石取石术的结石清除率平均高达 89%。
无管经皮肾镜碎石取石术在无并发症的手术、儿童、肥胖患者、同期双侧手术、肋脊角入路和合并解剖异常的肾脏中似乎是安全且有效的。在某些情况下仍应考虑放置肾造瘘管，如存在 2 个以上肾造瘘通道、需要二次探查或术中出现严重出血或集合系统穿孔等并发症的情况。
