Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio 43210, USA.
J Urol. 2013 Mar;189(3):823-7. doi: 10.1016/j.juro.2012.08.236. Epub 2012 Sep 23.
Drain placement after partial nephrectomy is considered standard but it is based on routine and not on evidence. With experience we performed robotic partial nephrectomy and routinely omitted a drain even with significant collecting system violation. We have rarely used drains after robotic partial nephrectomy for several years, and we report our outcomes.
We reviewed a single surgeon, prospective database of all robotic partial nephrectomies from February 2008 to March 2012, including the characteristics of those with and without a drain.
The 150 patients underwent a total of 160 robotic partial nephrectomy procedures with a drain used in 11 patients and omitted in 93%. Mean patient age was 57 years (range 22 to 89), mean American Society of Anesthesiologists score was 2.8 (range 2 to 4) and mean body mass index was 32 kg/m(2) (range 18 to 54). Values were similar in patients with and without a drain. In patients without a drain and in those with a drain mean tumor size was 3.5 cm (range 1.0 to 11.0) and 4.6 cm (range 1.1 to 8.6), and mean R.E.N.A.L. (radius, exophytic/endophytic, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines, hilar tumor touching main renal artery or vein) nephrometry score was 7.8 (range 4 to 12) and 8.8 (range 6 to 11), respectively. Collecting system violation occurred in 88 patients (59%), including 78 without a drain. Two patients (1.3%) required transfusion with no intervention for bleeding. All except 5 patients (97%) were discharged home on postoperative day 1 with all drains removed before discharge. In 2 patients (1.3%) without a drain small urinomas without infection developed more than 2 weeks postoperatively, which were treated with a week of Foley catheter drainage and percutaneous drainage, respectively.
Drain placement after robotic partial nephrectomy can be routinely omitted with a low rate of urine leaks, which can be managed safely when they rarely occur.
肾部分切除术后放置引流管被认为是标准操作，但这是基于常规而不是证据。随着经验的积累，我们进行了机器人辅助肾部分切除术，即使存在明显的集合系统侵犯，我们也常规不放置引流管。我们已经有好几年很少在机器人辅助肾部分切除术后使用引流管了，我们报告我们的结果。
我们回顾了 2008 年 2 月至 2012 年 3 月期间单外科医生前瞻性机器人辅助肾部分切除术数据库，包括有和无引流管的患者特征。
150 例患者共进行了 160 例机器人辅助肾部分切除术，其中 11 例患者放置引流管，93%的患者未放置引流管。患者平均年龄为 57 岁（范围 22 至 89 岁），平均美国麻醉医师协会评分 2.8（范围 2 至 4），平均体重指数为 32kg/m²（范围 18 至 54）。有和无引流管的患者的这些值相似。在无引流管的患者和有引流管的患者中，肿瘤平均大小分别为 3.5cm（范围 1.0 至 11.0）和 4.6cm（范围 1.1 至 8.6），R.E.N.A.L.（半径、外生性/内生性、肿瘤与集合系统或窦腔的接近程度、前后、相对于极线的位置、肾门肿瘤触及主肾动脉或静脉）肾切除术评分分别为 7.8（范围 4 至 12）和 8.8（范围 6 至 11）。有 88 例（59%）患者发生集合系统侵犯，其中 78 例无引流管。有 2 例（1.3%）患者需要输血，但未进行出血干预。除 5 例（97%）患者外，所有患者均于术后第 1 天出院，所有引流管均在出院前拔除。有 2 例（1.3%）无引流管的患者术后 2 周以上出现小尿囊肿而无感染，分别经 1 周的 Foley 导管引流和经皮引流治疗。
机器人辅助肾部分切除术后可常规不放置引流管，漏尿发生率低，当漏尿很少发生时，可安全处理。
