Department of Urology, Konya Research and Training Hospital, School of Medicine, Baskent University, Saray Street No. 1 Selcuklu, Konya, Turkey.
Urolithiasis. 2013 Aug;41(4):341-6. doi: 10.1007/s00240-013-0560-0. Epub 2013 Apr 21.
We aimed to investigate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) with ureteral catheter or double-J stent in comparison with standard PCNL in our study. We retrospectively evaluated 707 of 1,469 patients with stone area under 800 mm(2) and only one subcostal nephrostomy access that was underwent PCNL between March 2004 and October 2011 in our clinic. Patients with 14F nephrostomy tube (Malecot or Re-entry catheter), with ureteral stent and with antegrade double-J stent were included into Group 1 (n = 180), Group 2 (n = 148) and Group 3 (n = 120), respectively. The mean hospitalization time of patients in Group 1 was significantly longer. The mean VAS was significantly higher in Group 1. On the other hand the mean fluoroscopy and operation time of patients in Group 2 were significantly shorter in comparison with other groups. Number of patients with postoperative transfusion requirement was significantly higher in Group 1. The number of patients with postoperative narcotic analgesic requirement was also significantly higher in Group 1. The most frequent complication in our study was prolonged drainage. The postoperative complications were seen more frequently in Group 1. Both ureter catheter and double j stent were more comfortable, effective and safe in urinary drainage following PCNL with single sub-costal access. On the other hand, double-J stent has a disadvantage as requirement additional cystoscopy for removal. We suggest ureter catheter or double-J stent to preserve short- and long-term urinary drainage.
我们旨在研究无管经皮肾镜取石术(PCNL)联合输尿管导管或双 J 支架与标准 PCNL 的安全性和疗效。我们回顾性评估了 2004 年 3 月至 2011 年 10 月在我院接受 PCNL 治疗的 707 例结石面积小于 800mm²且仅有一个肋脊角入路的患者。我们将留置 14F 肾造瘘管(Malecot 或 Re-entry 导管)、输尿管支架和逆行双 J 支架的患者分别纳入第 1 组(n=180)、第 2 组(n=148)和第 3 组(n=120)。第 1 组患者的平均住院时间明显更长,平均 VAS 评分明显更高。另一方面,与其他组相比,第 2 组患者的平均透视和手术时间明显更短。第 1 组患者术后需要输血的人数明显更多。第 1 组患者术后需要使用麻醉性镇痛药的人数也明显更多。在我们的研究中,最常见的并发症是引流时间延长。第 1 组患者术后并发症更常见。在单个肋脊角入路的 PCNL 后,输尿管导管和双 J 支架在尿液引流方面更舒适、有效和安全。另一方面,双 J 支架需要额外的膀胱镜检查来取出,这是它的一个缺点。我们建议使用输尿管导管或双 J 支架进行短期和长期的尿液引流。