Moosanejad N, Firouzian A, Hashemi S A, Bahari M, Fazli M
Department of Urology, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Anesthesia and Intensive Care, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Braz J Med Biol Res. 2016;49(4):e4878. doi: 10.1590/1414-431X20154878. Epub 2016 Mar 18.
This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95 ± 13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube.
本研究旨在比较完全无管经皮肾镜取石术与标准经皮肾镜取石术在肾结石患者中的成功率和并发症发生率。患者被随机分为两组。44例患者（24例男性；平均年龄：50.40±2.02岁）接受完全无管经皮肾镜取石术（PCNL；PCNL术后不放置肾造瘘管或输尿管导管），40例患者（18例男性；平均年龄：49.95±13.38岁）接受标准PCNL（PCNL术后使用肾造瘘管和输尿管导管）。所有手术均由一名外科医生完成。比较两组患者术后血红蛋白变化、输血率、肌酐水平变化、手术时间、镇痛需求、住院时间和并发症发生率。两组患者在年龄、性别、结石大小和手术侧别方面无显著差异（P<0.05）。完全无管PCNL组的手术时间显著低于标准PCNL组（P=0.005）。标准PCNL组的哌替啶需求量显著高于完全无管PCNL组（P=0.007）。标准PCNL组的住院时间显著高于完全无管PCNL组（P<0.0001）。标准PCNL组的并发症发生率为15%，完全无管PCNL组为9.1%（P=0.73）。完全无管PCNL技术即使对于鹿角形结石患者也是安全有效的。该技术可减轻疼痛、减少镇痛需求以及缩短手术和住院时间。我们认为正常蠕动的输尿管是最好的引流管。
