Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, USA.
Int Braz J Urol. 2014 Mar-Apr;40(2):204-11. doi: 10.1590/S1677-5538.IBJU.2014.02.10.
Tubeless PCNL has been utilized to shorten hospital stay and improve patient postoperative pain control. Prior studies have excluded those patients with significant bleeding or other complications. Our objective was to evaluate the utility of tubeless PCNL in all patients irrespective of intraoperative outcome.
A retrospective review of the charts of patients who underwent PCNL at our institute was performed. Patients were assigned to one endourologist Who routinely performed tubeless PCNL and to a second endourologist who routinely left a small-bore pigtail nephrostomy. Preoperative demographics operative and postoperative outcomes were compared.
Out of 159 patients included, 83 patients had tubeless PCNL while 76 patients had standard PCNL. There was no difference between groups regarding age, gender, ASA score, number, maximum diameter of stones, number of calyces involved, Stone density (HU), laterality and use of preoperative narcotics. While staghorn stones were more common in patients who underwent standard PCNL (p = 0.008). Tubeless patients had less number of access tracts (p ≤ 0.001), shorter hospital stay (1.7 vs. 3.0 days, p = 0.001) when compared to standard PCNL group. Multivariable analysis controlling for confounding factors including staghorn calculi and number of accesses confirmed that tubeless PCNL was associated with shorter hospital stay and less postoperative pain. There was no significant difference in complication rates between the two groups.
Our report confirms the previous reports of shorter hospital stay, less pain and analgesia as compared to standard PCNL, and establishes its safety irrespective of bleeding, perforation, extravasation or other intraoperative issues that have previously been utilized as exclusionary criteria for this approach.
无管经皮肾镜取石术（tubeless PCNL）已被用于缩短住院时间并改善患者术后疼痛控制。先前的研究排除了那些有明显出血或其他并发症的患者。我们的目的是评估无论术中结果如何，无管经皮肾镜取石术在所有患者中的应用价值。
对在我们机构接受 PCNL 的患者的病历进行了回顾性分析。患者被分配给一位常规进行无管经皮肾镜取石术的腔内泌尿外科医生和一位常规留置小口径猪尾肾造瘘管的腔内泌尿外科医生。比较了术前人口统计学、手术和术后结果。
在纳入的 159 例患者中，83 例接受了无管经皮肾镜取石术，76 例接受了标准经皮肾镜取石术。两组患者在年龄、性别、ASA 评分、结石数量、最大结石直径、受累肾盏数量、结石密度（HU）、侧别和术前使用麻醉药物方面无差异。然而，标准经皮肾镜取石术组的鹿角形结石更为常见（p = 0.008）。无管经皮肾镜取石术组的通道数量较少（p ≤ 0.001），住院时间较短（1.7 天 vs. 3.0 天，p = 0.001）。多变量分析控制了包括鹿角形结石和通道数量在内的混杂因素，证实无管经皮肾镜取石术与较短的住院时间和较少的术后疼痛相关。两组的并发症发生率无显著差异。
我们的报告证实了先前的报告，即与标准经皮肾镜取石术相比，无管经皮肾镜取石术具有较短的住院时间、较少的疼痛和镇痛作用，并证明了其安全性，无论出血、穿孔、外渗或其他先前被用作该方法排除标准的术中问题如何。
