Kr Surag, Singh Anshuman, Sharma Pritam, Pai Vivek, Choudhary Anupam, Patil Shreenath
Urology, Kasturba Medical College, Manipal, IND.
Urology, A.J. Institute of Medical Sciences, Mangalore, IND.
Cureus. 2023 May 19;15(5):e39211. doi: 10.7759/cureus.39211. eCollection 2023 May.
Introduction This study focuses on investigating the effect of routine nephrostomy tube placement in patients with moderate renal calculi of size 2.5 cm or less who undergo uncomplicated percutaneous nephrolithotomy (PCNL) procedures. Previous studies have not specified whether only uncomplicated cases were included in the analysis, which may affect the results. This study aims to provide a clearer understanding of the effect of routine nephrostomy tube placement on blood loss in a more homogeneous patient population. Materials and methods A prospective randomized controlled trial (RCT) was conducted at our department over 18 months, dividing 60 patients with a single renal or upper ureteric calculus of size ≤2.5 cm into two groups: 30 patients in each group (group 1: tubed PCNL, group 2: tubeless PCNL). The primary outcome was the drop in perioperative hemoglobin level and the number of packed cell transfusions necessary. The secondary outcome included the mean pain score, analgesic requirement, length of hospital stay, time to return to normal activities, and the total cost of the procedure. Results The two groups were comparable in age, gender, comorbidities, and stone size. The postoperative hemoglobin level was significantly lower in the tubeless PCNL group (9.56 ± 2.13 gm/dL) compared to the tube PCNL group (11.32 ± 2.35 gm/dL) (p = 0.0037), and two patients in the tubeless group required blood transfusion. The duration of surgery, pain scores, and analgesic requirement were comparable between the two groups. The total procedure cost was significantly lower in the tubeless group (p = 0.0019), and the duration of hospital stay and time to return to daily activities were significantly shorter in the tubeless group (p < 0.0001). Conclusions Tubeless PCNL is a safe and effective alternative to conventional tube PCNL, with the advantages of shorter hospital stay, faster recovery, and lower procedure costs. Tube PCNL is associated with less blood loss and the need for transfusions. Patient preferences and bleeding risk should be considered when choosing between the two procedures.
引言 本研究聚焦于调查对于大小为2.5厘米或更小的中度肾结石且接受无并发症经皮肾镜取石术（PCNL）的患者，常规放置肾造瘘管的效果。既往研究未明确分析中是否仅纳入了无并发症的病例，这可能会影响结果。本研究旨在更同质的患者群体中更清晰地了解常规放置肾造瘘管对失血的影响。
材料与方法 在我们科室进行了一项为期18个月的前瞻性随机对照试验（RCT），将60例单个肾或上段输尿管结石大小≤2.5厘米的患者分为两组：每组30例患者（第1组：带管PCNL，第2组：无管PCNL）。主要结局是围手术期血红蛋白水平的下降以及所需的浓缩红细胞输注次数。次要结局包括平均疼痛评分、镇痛需求、住院时间、恢复正常活动的时间以及手术的总费用。
结果 两组在年龄、性别、合并症和结石大小方面具有可比性。无管PCNL组术后血红蛋白水平（9.56±2.13克/分升）显著低于带管PCNL组（11.32±2.35克/分升）（p = 0.0037），无管组有2例患者需要输血。两组之间手术持续时间、疼痛评分和镇痛需求具有可比性。无管组的手术总费用显著更低（p = 0.0019），无管组的住院时间和恢复日常活动的时间显著更短（p < 0.0001）。
结论 无管PCNL是传统带管PCNL的一种安全有效的替代方法，具有住院时间短、恢复快和手术费用低的优点。带管PCNL与失血更少和输血需求相关。在两种手术方法之间进行选择时，应考虑患者的偏好和出血风险。
