Chen Qi, Cao Yang, Xia Lei, Zhong Hai, Du Zhebin, Xuan Hanqing, Lu Mujun
Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Transl Androl Urol. 2021 Feb;10(2):654-661. doi: 10.21037/tau-20-1060.
To retrospectively assess the experience of day-surgery semi tubeless ultra-mini percutaneous nephrolithotomy (UMP) for the treatment of kidney stones by experienced surgeons.
Clinical data of 358 patients with kidney stones (254 males and 104 females; mean age: 59.60±11.70) who were performed UMP surgery in Shanghai Jiao Tong University School of Medicine affiliated Renji Hospital from June 2015 to December 2018. Patient demographics, operative data, complications, and readmission rates were recorded. Day-surgery UMP was defined as discharge of patients either the same day or within 24 h after surgery. Semi tubeless UMP was defined as no placement of DJ and nephrostomy tube after surgery.
The average size of stones was 14.56±6.24 mm (range, 4-30 mm). There are solitary stones in 192 cases, multiple stones in 142 cases and 29 cases with Staghorn stones. F13 outer sheath was used for all operations; 358 patients completed UMP on the day of admission; 326 (91.06%) patients achieved same-day discharge or received overnight observation prior to discharge, and 32 patients (8.94%) required full admission (longer than 24 h). The readmission rate was 0.56% (2 patients). The postoperative complications within 1 week occurred in 36 (10.06%) patients, including 23, 10, 3 of grades I, II, IIIa complications (Clavien-System). The average operation time was 29.64 min and the hemoglobin drop were 13.42±9.55 g/L. The stone clearance rate was 91.62% (328/358). The semi tubeless rate war 95.25% (341/358).
For day-surgery semi tubeless UMP, experienced surgeons gain excellent patient outcomes in appropriately selected patients. Day-surgery semi tubeless UMP is worth promoting.
回顾性评估经验丰富的外科医生采用日间手术半无管超微经皮肾镜取石术（UMP）治疗肾结石的经验。
收集2015年6月至2018年12月在上海交通大学医学院附属仁济医院接受UMP手术的358例肾结石患者（男254例，女104例；平均年龄：59.60±11.70岁）的临床资料。记录患者人口统计学资料、手术数据、并发症及再入院率。日间手术UMP定义为患者在手术当天或术后24小时内出院。半无管UMP定义为术后不放置DJ管和肾造瘘管。
结石平均大小为14.56±6.24mm（范围4 - 30mm）。单发结石192例，多发结石142例，鹿角形结石29例。所有手术均采用F13外鞘；358例患者入院当日完成UMP手术；326例（91.06%）患者实现当日出院或在出院前接受过夜观察，32例（8.94%）患者需要全住院（超过24小时）。再入院率为0.56%（2例患者）。1周内术后并发症发生在36例（10.06%）患者中，包括I、II、IIIa级并发症（Clavien分级系统）分别为23例、10例、3例。平均手术时间为29.64分钟，血红蛋白下降13.42±9.55g/L。结石清除率为91.62%（328/358）。半无管率为95.25%（341/358）。
对于日间手术半无管UMP，经验丰富的外科医生在适当选择的患者中可获得优异的患者结局。日间手术半无管UMP值得推广。
