Chang Chien-Hsing, Wang Chung-Jing, Huang Shi-Wei
Division of Urology, Department of Surgery, Saint Martin De Porres Hospital, Chiayi, Taiwan, R.O.C.
Urol Res. 2011 Dec;39(6):459-65. doi: 10.1007/s00240-011-0363-0. Epub 2011 Feb 18.
The purpose of this study was to perform a randomized controlled trial to evaluate the role, safety, and effectiveness of totally tubeless PCNL and whether this procedure is less morbid in terms of analgesia requirement, related complications and convalescence. A total of 131 patients, with impacted ureteropelvic junction stone or single renal pelvic stone larger than 20 mm, were prospectively randomized (using random numbers table) into two groups, and underwent conventional (63 patients) or totally tubeless (68 patients) PCNL. Preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasonography, intravenous urography and Tc 99m DTPA clearance for determination of selective glomerular filtration rate. Intraoperative findings, operative time, and outcome were also recorded. All patients were followed regularly at clinic every 3 months during year 1 and every 6 months, thereafter, and Tc 99m DTPA clearance for the determination of selective glomerular filtration rate, renal ultrasonography and intravenous urography was performed to assess the kidney function 6 months later. There was no difference between the groups with regard to serum creatinine change, hemoglobin decrease, morphology improvement, resumption of normal activity and complication grading. The length of stay, pain visual analog scale and analgesic requirements favored the tubeless group with statistical significance. There was significant statistical difference in relative perfusion rate between preoperative and postoperative in both groups. This trial demonstrates that totally tubeless PCNL is safe and well tolerated in selected patients and associated with decreases in length of stay, postoperative pain and analgesia requirement. Most importantly, patients undergoing uncomplicated PCNL are not mandated to have a nephrostomy or ureteral stent placed for specific indications.
本研究的目的是进行一项随机对照试验，以评估完全无管经皮肾镜取石术（PCNL）的作用、安全性和有效性，以及该手术在镇痛需求、相关并发症和康复方面是否病态较轻。共有131例患有输尿管肾盂连接部结石嵌顿或单个肾盂结石大于20 mm的患者，前瞻性地（使用随机数字表）随机分为两组，分别接受传统PCNL（63例）或完全无管PCNL（68例）。术前数据包括尿液分析、尿培养、全血细胞计数、生化研究、肾脏超声、静脉肾盂造影和Tc 99m二乙三胺五乙酸清除率以测定选择性肾小球滤过率。还记录了术中发现、手术时间和结果。所有患者在第1年每3个月、此后每6个月在门诊定期随访，并在6个月后进行Tc 99m二乙三胺五乙酸清除率以测定选择性肾小球滤过率、肾脏超声和静脉肾盂造影以评估肾功能。两组在血清肌酐变化、血红蛋白降低、形态改善、恢复正常活动和并发症分级方面无差异。住院时间、疼痛视觉模拟评分和镇痛需求有利于无管组，具有统计学意义。两组术前和术后的相对灌注率有显著统计学差异。该试验表明，完全无管PCNL在选定患者中是安全且耐受性良好的，并且与住院时间、术后疼痛和镇痛需求的减少相关。最重要的是，接受无并发症PCNL的患者无需因特定指征而放置肾造瘘管或输尿管支架。
