Bellman G C, Davidoff R, Candela J, Gerspach J, Kurtz S, Stout L
Department of Urology, Kaiser Permanente, Los Angeles, California, USA.
J Urol. 1997 May;157(5):1578-82.
We challenge the requirement for routine placement of a nephrostomy tube following percutaneous renal surgery.
A total of 50 patients underwent tubeless percutaneous renal procedures consisting of nephrolithotripsy, endopyelotomy, and stone extraction plus endopyelotomy performed during the same setting. In the initial 30 patients a Double-J* stent and a Councill nephrostomy tube were placed at the end of the procedure. The Councill catheter was removed 2 to 3 hours postoperatively. The subsequent 20 patients received only a Double-J stent with no Councill catheter. This study group was compared to a control group of 50 age, sex and procedure matched patients who had previously undergone standard percutaneous renal procedures with routine placement of postoperative nephrostomy tubes. The incidence of complications, analgesia requirements, length of hospitalization, interval to return to normal activities and cost of treatment were compared between the 2 groups.
All 50 tubeless percutaneous procedures were performed successfully without significant complications. In the initial 15 patients postoperative renal ultrasound demonstrated no urinoma. Hospitalization was 0.6 days for the study group and 4.6 days for the controls (p = 0.0001). Average parenteral or intramuscular analgesia requirements were 11.58 and 36.06 mg. morphine sulfate, respectively (p = 0.0001), with patients requiring oral analgesia for 5.9 and 11.7 days, respectively (p = 0.0001). Patients in the study group returned to normal activities within 17.85 days versus 26.6 days for the controls (p = 0.0004). The costs of the procedures were $1,638 and $3,750 (129% greater), respectively, for a cost saving of $2,112 per case.
Tubeless percutaneous renal surgery is a safe procedure and offers numerous advantages over routine placement of a nephrostomy tube. The hospitalization, analgesia requirements, return to normal activities as well as cost are significantly less with this new technique.
我们对经皮肾手术后常规放置肾造瘘管的必要性提出质疑。
共有50例患者接受了无管经皮肾手术，包括碎石术、肾盂内切开术以及在同一手术过程中进行的取石术加肾盂内切开术。最初的30例患者在手术结束时放置了双J支架和考恩西尔肾造瘘管。考恩西尔导管在术后2至3小时拔除。随后的20例患者仅接受了双J支架，未放置考恩西尔导管。将该研究组与一个由50例年龄、性别和手术相匹配的患者组成的对照组进行比较，这些对照患者此前接受了术后常规放置肾造瘘管的标准经皮肾手术。比较两组之间的并发症发生率、镇痛需求、住院时间、恢复正常活动的间隔时间以及治疗费用。
所有50例无管经皮手术均成功完成，无明显并发症。最初的15例患者术后肾脏超声检查未发现尿瘤。研究组的住院时间为0.6天，对照组为4.6天（p = 0.0001）。平均胃肠外或肌肉注射镇痛需求量分别为11.58和36.06毫克硫酸吗啡（p = 0.0001），患者分别需要口服镇痛5.9天和11.7天（p = 0.0001）。研究组患者在17.85天内恢复正常活动，而对照组为26.6天（p = 0.0004）。手术费用分别为1638美元和3750美元（高出129%），每例节省费用2112美元。
无管经皮肾手术是一种安全的手术方式，与常规放置肾造瘘管相比具有诸多优势。这项新技术在住院时间、镇痛需求、恢复正常活动以及费用方面都显著更低。
