Candela J, Davidoff R, Gerspach J, Bellman G C
Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.
Tech Urol. 1997 Spring;3(1):6-11.
We describe our modification of the technique of traditional percutaneous renal surgery called "tubeless" percutaneous renal surgery. Fifty patients have now undergone percutaneous renal procedures without the use of a postoperative nephrostomy tube consisting of percutaneous nephrolithotripsy, percutaneous endopyelotomy, and both percutaneous stone extraction and endopyelotomy in the same setting. Our current modification of standard percutaneous surgical technique includes the placement of an internal ureteral catheter with primary closure of the access site using hemostatic skin sutures. The study group was compared to a control group of 50 patients who were age, sex and procedure matched who had undergone standard percutaneous renal procedures previously with routine placement of postoperative nephrostomy tubes. The incidence of complications, analgesia requirements, length of hospitalization, time of return to normal activities, and cost of treatment were compared between the two groups. All tubeless percutaneous procedures were successfully performed without significant complications. The initial 15 patients had postoperative renal ultrasounds demonstrating no urinoma. Hospital stay, analgesia requirements, and the patient's ability to return to normal activities were statistically significantly decreased in the patient group studied. The cost of a "tubeless" procedure was $1,638 compared with $3,750 (129% greater) for traditional percutaneous surgery (cost saving of $2,112/case). Tubeless percutaneous renal surgery is a safe procedure and offers advantages over the routine placement of a nephrostomy tube. The hospitalization period, analgesia requirements, return to normal activities, and cost are significantly less with this new technique.
我们描述了对传统经皮肾手术技术的改良，即所谓的“无管”经皮肾手术。目前已有50例患者接受了经皮肾手术，术后未使用肾造瘘管，这些手术包括经皮肾镜碎石术、经皮肾盂内切开术，以及在同一手术中同时进行经皮取石和肾盂内切开术。我们目前对标准经皮手术技术的改良包括放置一根输尿管内导管，并使用皮肤止血缝线对手术入路部位进行一期缝合。将研究组与一个由50例患者组成的对照组进行比较，对照组患者在年龄、性别和手术方面相匹配，他们之前接受过标准的经皮肾手术，术后常规放置肾造瘘管。比较了两组之间的并发症发生率、镇痛需求、住院时间、恢复正常活动的时间以及治疗费用。所有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显示无尿瘤形成。在研究的患者组中，住院时间、镇痛需求以及患者恢复正常活动的能力在统计学上均显著降低。“无管”手术的费用为1638美元，而传统经皮手术的费用为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，与常规放置肾造瘘管相比具有优势。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均显著降低。
