Aghamir Seyed Mohammad Kazem, Mohseni Mohammad Ghasem, Hosseini Seyed Reza, Salavati Alborz, Ganjali Hossein, Fallah Mohammad Ali, Rezaei Hamed, Modaresi Seyed Saeed
Department of Urology, Tehran University of Medical Sciences, Tehran, Iran.
Turk J Urol. 2017 Jun;43(2):162-164. doi: 10.5152/tud.2017.03185. Epub 2017 Jun 1.
Regarding technical difficulties that obese body habitus might impose to percutaneous nephrolithotomy (PNL) success and higher risk of peri-operative complications in this group of patients, we decided to retrospectively gather data from our patients during past 8 years to determine the stone free and complication rates.
Between January 2007-December 2015, seventy-eight obese patients with body mass index over 35 who had indication for PNL including stones larger than 2 cm in pelvi-calyceal system or smaller extracorporeal shock wave lithotripsy (ESWL) resistant stones or who were not a fit candidate for ESWL due to increased skin to target distance, with no contraindication of PNL (including bleeding diathesis, inability to be positioned in prone) were enrolled. They were randomly assigned to group 1 (standard PNL with nephrostomy and ureteral stent) or group 2 (totally tubeless PNL with no ureteral stent and no nephrostomy). The outcomes were compared.
The transfusion rate, operation time, and the hemoglobin drop were same across the groups (p>0.05). Total analgesic use was equivalent of 33.8 vs. 14.7 mgs of morphine sulfate (18-77 mg) and was significantly lower in total tubeless group (p=0.001). Return to normal activity was described as total number of in-patient and outpatient days from time of admission to the point which the patients returns to normal life activity such as going to job or school and was 19.4 vs. 9.3 days (6-30 days, p=0.001).
Totally tubeless PNL in obese subjects would have lower analgesic use and return to normal activity versus standard PNL. Totally tubeless PNL is recommended for obese patients.
鉴于肥胖体型可能给经皮肾镜取石术（PNL）的成功带来技术困难，且该组患者围手术期并发症风险较高，我们决定回顾性收集过去8年中我们患者的数据，以确定结石清除率和并发症发生率。
2007年1月至2015年12月，纳入78例体重指数超过35的肥胖患者，这些患者有PNL指征，包括肾盂肾盏系统结石大于2 cm、体外冲击波碎石术（ESWL）治疗无效的较小结石，或因皮肤至靶点距离增加而不适合ESWL治疗且无PNL禁忌证（包括出血倾向、无法俯卧位）的患者。他们被随机分为第1组（标准PNL并留置肾造瘘管和输尿管支架）或第2组（完全无管PNL，不留置输尿管支架和肾造瘘管）。比较两组结果。
两组的输血率、手术时间和血红蛋白下降情况相同（p>0.05）。总镇痛药物用量相当于33.8 vs. 14.7 mg硫酸吗啡（18 - 77 mg），完全无管组显著更低（p = 0.001）。恢复正常活动定义为从入院到患者恢复正常生活活动（如上班或上学）的住院和门诊总天数，分别为19.4天和9.3天（6 - 30天，p = 0.001）。
与标准PNL相比，肥胖患者采用完全无管PNL镇痛药物用量更低且恢复正常活动更快。推荐肥胖患者采用完全无管PNL。
