Marchant Fernando, Recabal Pedro, Fernández Mario I, Osorio Francisco, Benavides Javiera
Department of Urology, Hospital Clínico Universidad de Chile, Santiago, Chile.
Urol Res. 2011 Dec;39(6):477-81. doi: 10.1007/s00240-011-0367-9. Epub 2011 Feb 20.
Percutaneous Nephrolithotomy (PNL) is an established technique for the treatment of renal calculi. Some reports have challenged the need for a nephrostomy tube at the end of the procedure, arguing that it accounts for a longer hospital stay and increased postoperative pain. During the last years, several series have addressed the feasibility and safety of tubeless PNL, where a double-J ureteral stent is left in place after the end of intervention instead of a nephrostomy tube. The aim of our study was to compare conventional versus tubeless PNL in terms of postoperative morbidity. Eighty-five patients who underwent PNL at a single center met the inclusion criteria (complete intraoperative stone clearance, no evidence of active intraoperative bleeding, single percutaneous access, and operative time shorter than 2 h) and were randomized at the end of the procedure to have placed either a nephrostomy tube (group 1) or a double-J ureteral stent (group 2). Outcomes assessed were postoperative pain, bleeding complications, leakage complications, and length of hospital stay. The patients in the tubeless group had a shorter hospital stay (3.7 vs. 5.8 days; P < 0.001), and less postoperative pain at postoperative days 2 and 3 (P < 0.001). No significant difference in bleeding or leakage complications was observed. This study supports the feasibility and safety of tubeless PNL in a selected group of the patients, suggesting some intraoperative criteria to be considered when performing it. However, further controlled studies will have to determine its impact on stone-free rates prior to be considered the standard technique in these selected cases.
经皮肾镜取石术（PNL）是一种成熟的治疗肾结石的技术。一些报告对术后放置肾造瘘管的必要性提出了质疑，认为这会导致住院时间延长和术后疼痛加剧。在过去几年中，有几个系列研究探讨了无管PNL的可行性和安全性，即在干预结束后留置双J输尿管支架而不是肾造瘘管。我们研究的目的是比较传统PNL和无管PNL的术后发病率。在单一中心接受PNL的85例患者符合纳入标准（术中结石完全清除、无术中活动性出血迹象、单一经皮穿刺通道且手术时间短于2小时），并在手术结束时随机分为两组，一组放置肾造瘘管（第1组），另一组放置双J输尿管支架（第2组）。评估的结果包括术后疼痛、出血并发症、渗漏并发症和住院时间。无管组患者的住院时间较短（分别为3.7天和5.8天；P<0.001），且在术后第2天和第3天的术后疼痛较轻（P<0.001）。在出血或渗漏并发症方面未观察到显著差异。本研究支持在部分选定患者中无管PNL的可行性和安全性，提示在进行该手术时应考虑一些术中标准。然而，在被视为这些选定病例的标准技术之前，还需要进一步的对照研究来确定其对结石清除率的影响。
