Alyaev Ju G, Grigoriev N A, Sorokin N I, Diakonov I V, Ali S H
Sechenov First Moscow State Medical University, Moscow, Research Institute of Uronephrology and Human Reproductive Health.
Urologiia. 2016 Aug(3):38-43.
to compare various methods of upper urinary tract drainage in patients with urolithiasis.
60 patients were included into a prospective study which ran from March 2013 through December 2014. All patients underwent PCNL with a nephrostomy tract diameter of (28-30 Ch.) at the I.M. Sechenov First Moscow State Medical University urology clinic. Patients were divided into 2 groups. Group 1 30 (patients) underwent nephrostomy after PCNL with nephrostomy tract placement, in group 2 (29 patients) internal drainage was performed. One patient withdrew from the study due to residual stone. Adequacy of urinary tract draining was assessed by operative time and blood loss. A comparative analysis was performed to outline difference in both groups by length of hospital stay, severity of flank pain in early postoperative period and 5 days after the procedure, day of drain removal.
the average operative time in group No1 was 104 minutes (+/-17 min.), and 71 minutes (+/- 19 minutes) in group No2 . The average hemoglobin level before surgery in both groups was roughly comparable and amounted to: 141.5g / l (+/-13) in group No1, in group No 2 143.6 g / l (+/-18). At the same time, hemoglobin level in the early postoperative period varied in both groups and was as follows: 121g / l (+/-13) in group No1, and 128g / l (+/-14) in group 2. Evaluation of pain severity by VAS score showed that severity of pain in an early postoperative period was roughly comparable in both groups and amounted to 6.29 and 6.05 points, respectively, but from the second day, and since the activation of the patients, the values of the intensity of pain in both groups became differ. Group No1: - 5.33 (+/-1.5) on day 2, 3.25 (+/-1.8) on day 3, - 2.5 (+/-1.6) on day 5. A more thorough elucidation of the cause of pain showed that in 56 (88%) patients the pain was due to the nephrostomy and pain in the nephrostomy stroke while driving and only 7 (11%) patients complained of a pain in the operated kidney. Group No2: - 3.5 (+/-1.2) on day 2, - 2.9 (+/-1.4) on day 3, 1.22 (+/-0.8) on day 5.
A detailed and thorough history, taking together with multislice computed tomography and multiplanar 3D modeling allows for better preoperative assessment regarding a size, a number and location of stones, vascular architecture of the kidney. This enebles an experienced endoscopic surgeon to plan an operation, and avoid the possible difficulties associated with lithotripsy and choose a more suitable method of pyelocaliceal system draining after the operation. In turn, tubeless PCNL, with proper intraoperative managamant and careful selection of patients appears to be safe and effective. Drainage of the upper urinary tract with internal drainage reduces intensity of postoperative pain, which improves the quality of life of patients in the postoperative period, and reduces the length of postoperative stay.
比较尿路结石患者上尿路引流的各种方法。
60例患者纳入了一项从2013年3月至2014年12月的前瞻性研究。所有患者均在莫斯科第一谢马什克国立医科大学泌尿外科诊所接受经皮肾镜取石术（PCNL），肾造瘘通道直径为（28 - 30 Ch.）。患者分为2组。第1组30例患者在PCNL后进行肾造瘘通道放置肾造瘘术，第2组29例患者进行内引流。1例患者因残留结石退出研究。通过手术时间和失血量评估尿路引流的充分性。通过住院时间、术后早期和术后5天的胁腹疼痛严重程度、引流管拔除日进行比较分析，以概述两组之间的差异。
第1组的平均手术时间为104分钟（±17分钟），第2组为71分钟（±19分钟）。两组术前平均血红蛋白水平大致相当，第1组为141.5g / l（±13），第2组为143.6 g / l（±18）。同时，两组术后早期血红蛋白水平有所不同，如下：第1组为121g / l（±13），第2组为128g / l（±14）。通过视觉模拟评分法（VAS）评估疼痛严重程度显示，两组术后早期疼痛严重程度大致相当，分别为6.29分和6.05分，但从第二天起，随着患者活动，两组疼痛强度值开始出现差异。第1组：术后第2天为5.33（±1.5）分，第3天为3.25（±1.8）分，第5天为2.5（±1.6）分。对疼痛原因更深入的分析表明，56例（88%）患者的疼痛是由于肾造瘘术以及肾造瘘通道内操作时的疼痛，只有7例（11%）患者抱怨手术侧肾脏疼痛。第2组：术后第2天为3.5（±1.2）分，第3天为2.9（±1.4）分，第5天为1.22（±0.8）分。
详细全面的病史，结合多层螺旋计算机断层扫描和多平面3D建模，有助于对结石的大小、数量和位置、肾脏血管结构进行更好的术前评估。这使经验丰富的内镜外科医生能够规划手术，避免与碎石术相关的可能困难，并在术后选择更合适的肾盂肾盏系统引流方法。反过来，无管PCNL，通过适当的术中管理和仔细选择患者，似乎是安全有效的。采用内引流进行上尿路引流可减轻术后疼痛强度，这改善了患者术后的生活质量，并缩短了术后住院时间。
