无管化与传统PCNL治疗肾、输尿管上段结石的临床研究

doi:10.3760/cma.j.issn.1007-1245.2022.10.011

摘要/Abstract

摘要： 目的　分析无管化经皮肾镜取石术（PCNL）和传统PCNL治疗肾、输尿管上段结石的安全性和有效性。方法　前瞻性收集英德市人民医院2019年5月至2021年11月期间收治的72例结石负荷相当的输尿管上段结石和/或肾结石的患者，简单随机分为两组，无管化组36例、传统组36例，比较两组患者手术的结石清除率、手术时间、术后并发症、住院费用、术后疼痛等。计量资料采用t检验，计数资料采用卡方检验或Fisher确切概率法。结果　无管化组与传统组分别在手术时间［（81.67±3.02）min比（95.56±5.17）min］、住院时间［（6.33±0.20）d比（9.52±0.22）d］、住院费用［（12 580±269.7）元比（14 199±208.6）元］、拔尿管时间［（2.75±0.13）d比（6.06±0.07）d］、术后下床活动时间［（14.33±1.98）h比（70.00±2.40）h］、术后疼痛评分［（1.72±0.18）分比（4.06±0.29）分］方面差异均有统计学意义（均P<0.05）；而在血红蛋白下降值、肾周血肿率、发热率、结石清除率方面差异均无统计学意义（均P>0.05）。结论　无管化PCNL治疗肾、输尿管上段结石安全有效，相对于传统PCNL具有减轻患者术后疼痛感、早期下床活动、早期拔除尿管、促进患者术后康复、缩短住院时间、减少住院费用的优势。

关键词: 经皮肾镜取石术, 无管化, 肾结石, 输尿管上段结石, 安全性, 有效性

Abstract:

Objective　To analyze the safety and efficacy of tubeless and traditional percutaneous nephrolithotomy (PCNL) in the treatment of renal and upper ureteral calculi. Methods　A total of 72 patients with upper ureteral calculi and/or renal calculi with comparable calculus burden who were admitted to Yingde People's Hospital from May 2019 to November 2021 were prospectively collected and were simply randomly divided into two groups, with 36 cases in the tubeless group and 36 cases in the traditional group. The stone clearance rate, operation time, postoperative complications, hospitalization cost, and postoperative pain were compared between the two groups. t test was used for the measurement data, and Chi-square test or Fisher's exact test was used for the count data. Results　There were statistically significant differences in the operation time [(81.67±3.02) min vs. (95.56±5.17) min], hospital stay [(6.33±0.20) d vs. (9.52±0.22) d], hospitalization cost [(12 580±269.7) yuan vs. (14 199±208.6) yuan], time of extubation [(2.75±0.13) d vs. (6.06±0.07) d], postoperative ambulation time [(14.33±1.98) h vs. (70.00±2.40) h], and postoperative pain score [(1.72±0.18) points vs. (4.06±0.29) points] between the tubeless group and the traditional group (all P<0.05), while there were no statistically significant differences in the decrease of hemoglobin and rates of perirenal hematoma, fever, and stone clearance (all P>0.05). Conclusion　Tubeless PCNL is safe and effective in the treatment of renal and upper ureteral calculi, and has the advantages of reducing the postoperative pain, early out of bed activity, early removal of urinary catheters, promoting the postoperative rehabilitation, shortening the hospital stay, and reducing the hospitalization cost compared with traditional PCNL.

Key words: Percutaneous nephrolithotomy, , Tubeless, , Renal calculi, , Upper ureteral calculi, Safety, Efficacy

潘小龙, 李晓, 衡宝利, 朱光建, 黄振, 吴凡宇. 无管化与传统PCNL治疗肾、输尿管上段结石的临床研究[J]. 国际医药卫生导报, 2022, 28(10): 1377-1380.

Pan Xiaolong, Li Xiao, Heng Baoli, Zhu Guangjian, Huang Zhen, Wu Fanyu. Clinical study on the treatment of renal and upper ureteral calculi by tubeless and traditional PCNL[J]. International Medicine and Health Guidance News, 2022, 28(10): 1377-1380.

参考文献

[1] Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique[J]. Scand J Urol Nephrol, 1976, 10(3):257-259. DOI: 10.1080/21681805.1976.11882084.

[2] Moosanejad N, Firouzian A, Hashemi SA, et al. Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized, clinical trial[J]. Braz J Med Biol Res, 2016, 49(4):e4878. DOI: 10.1590/1414-431X20154878.

[3] Alken P. Percutaneous nephrolithotomy - the puncture[J]. BJU Int, 2022, 129(1):17-24. DOI: 10.1111/bju.15564.

[4] Li Q, Gao L, Li J, et al. Total tubeless versus standard percutaneous nephrolithotomy: a meta-analysis[J]. Minim Invasive Ther Allied Technol, 2020, 29(2):61-69. DOI: 10.1080/13645706.2019.1581224.

[5] Veser J, Fajkovic H, Seitz C. Tubeless percutaneous nephrolithotomy: evaluation of minimal invasive exit strategies after percutaneous stone treatment[J]. Curr Opin Urol, 2020, 30(5):679-683. DOI: 10.1097/MOU.0000000000000802.

[6] Liu Y, Zhu W, Zeng G. Percutaneous nephrolithotomy with suction: is this the future?[J]. Curr Opin Urol, 2021, 31(2):95-101. DOI: 10.1097/MOU.0000000000000854.

[7] Ghani KR, Andonian S, Bultitude M, et al. Percutaneous nephrolithotomy: update, trends, and future directions[J]. Eur Urol, 2016, 70(2):382-396. DOI: 10.1016/j.eururo.2016.01.047.

[8] de Cógáin MR, Krambeck AE. Advances in tubeless percutaneous nephrolithotomy and patient selection: an update[J]. Curr Urol Rep, 2013, 14(2):130-137. DOI: 10.1007/s11934-013-0310-4.

[9] Chen ZJ, Yan YJ, Zhou JJ. Comparison of tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a meta-analysis of randomized trials[J]. Asian J Surg, 2020, 43(1):60-68. DOI: 10.1016/j.asjsur.2019.01.016.

[10] Raharja PAR, Atmoko W, Rasyid N, et al. Safety and effectiveness of externalized ureteral catheter in tubeless percutaneous nephrolithotomy[J]. Urol J, 2019, 17(5):456-461. DOI: 10.22037/uj.v0i0.5280.

[11] Ibrahim A, Wollin D, Preminger G, et al. Technique of percutaneous nephrolithotomy[J]. J Endourol, 2018, 32(S1):S17-S27. DOI: 10.1089/end.2018.0047.

[12] Goldberg H, Nevo A, Shtabholtz Y, et al. Tubeless supra-costal percutaneous nephrolithotomy is associated with significantly less hydrothorax: a prospective randomized clinical study[J]. BJU Int, 2020, 125(2):276-283. DOI: 10.1111/bju.14950.

[13] Xun Y, Wang Q, Hu H, et al. Tubeless versus standard percutaneous nephrolithotomy: an update meta-analysis[J]. BMC Urol, 2017, 17(1):102. DOI: 10.1186/s12894- 017-0295-2.

[14] 朱瑞龙,蔡超,吴荣海,等.小于2 cm单发性肾结石3种手术方法比较[J].国际医药卫生导报,2021,27(9):1381-1385. DOI:10.3760/cma.j.issn.1007-1245.2021.09.027.

[15] Minami T, Yamana H, Matsui H, et al. Postoperative outcomes after tubeless, totally tubeless, standard, and standard with ureteral stent percutaneous nephrolithotomy: a nationwide retrospective study in Japan[J]. Urol Int, 2020, 104(5-6):445-451. DOI: 10.1159/000505103.

[16] Chen Q, Cao Y, Xia L, et al. The retrospective experience of day-surgery semi tubeless ultra-mini percutaneous nephrolithotomy[J]. Transl Androl Urol, 2021, 10(2):654-661. DOI: 10.21037/tau-20-1060.

[17] Tirtayasa PMW, Yuri P, Birowo P, et al. Safety of tubeless or totally tubeless drainage and nephrostomy tube as a drainage following percutaneous nephrolithotomy: a comprehensive review[J]. Asian J Surg, 2017, 40(6):419-423. DOI: 10.1016/j.asjsur.2016.03.003.

[18] 邱剑光,张晓阳,王德娟,等.Gyrus等离子柱状电极应用于经皮肾镜术穿刺通道主动止血的临床研究[J/CD].中华腔镜泌尿外科杂志(电子版),2010,4(1):13-16. DOI:10.3969/j.issn.1674-3253.2010.01.005.

[19] 王学雷,黄立群,王金善,等.新型止血内鞘在无管化经皮肾镜中的临床应用[J/CD].中华腔镜泌尿外科杂志(电子版),2021,15(2):103-107. DOI: 10.3877/cma.j.issn.1674- 3253.2021.02.004.

[20] 覃志华,黄侃慧,朱万昇,等.无管化经皮肾手术与普通微创经皮肾手术在肾结石治疗中比较[J].华夏医学,2016,29(5):61-63. DOI:10.19296/j.cnki.1008-2409.2016-05-015.

[21] Karani R, Arada RB, Okhunov Z, et al. Endoscopic guided percutaneous nephrolithotomy[J]. J Endourol, 2021, 35(S2):S62-S67. DOI: 10.1089/end.2020.0556.

[22] Zeng G, Cai C, Duan X, et al. Mini percutaneous nephrolithotomy is a noninferior modality to standard percutaneous nephrolithotomy for the management of 20-40mm renal calculi: a multicenter randomized controlled trial[J]. Eur Urol, 2021, 79(1):114-121. DOI: 10.1016/j.eururo.2020.09.026.

[23] DiBianco JM, Ghani KR. Precision stone surgery: current status of miniaturized percutaneous nephrolithotomy[J]. Curr Urol Rep, 2021, 22(4):24. DOI: 10.1007/s11934- 021-01042-0.

[24] Choi SW, Kim KS, Kim JH, et al. Totally tubeless versus standard percutaneous nephrolithotomy for renal stones: analysis of clinical outcomes and cost[J]. J Endourol, 2014, 28(12):1487-1494. DOI: 10.1089/end.2014.0421.

[25] Kallidonis P, Vagionis A, Vrettos T, et al. Non papillary mini-percutaneous nephrolithotomy: early experience[J]. World J Urol, 2021, 39(4):1241-1246. DOI: 10.1007/s00345-020-03267-z.

[26] Jones P, Aboumarzouk OM, Zelhof B, et al. Percutaneous nephrolithotomy in patients with chronic kidney disease: efficacy and safety[J]. Urology, 2017, 108:1-6. DOI: 10.1016/j.urology.2017.05.019.

[27] Istanbulluoglu OM, Ozturk B, Cicek T, et al. Case report: bilateral simultaneous tubeless and stentless percutaneous nephrolithotomy[J]. J Endourol, 2008, 22(1):25-28. DOI: 10.1089/end.2007.0037.

[28] Gupta NP, Mishra S, Suryawanshi M, et al. Comparison of standard with tubeless percutaneous nephrolithotomy[J]. J Endourol, 2008, 22(7):1441-1446. DOI: 10.1089/end.2007.0338.

[29] Maheshwari PN, Andankar MG, Bansal M. Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter?[J]. J Endourol, 2000, 14(9):735-737; discussion 737-738. DOI: 10.1089/end.2000.14.735.

[30] Giusti G, Piccinelli A, Maugeri O, et al. Percutaneous nephrolithotomy: tubeless or not tubeless?[J]. Urol Res, 2009, 37(3):153-158. DOI: 10.1007/s00240-009-0183-7.

[31] Sofikerim M, Demirci D, Huri E, et al. Tubeless percutaneous nephrolithotomy: safe even in supracostal access[J]. J Endourol, 2007, 21(9):967-972. DOI: 10.1089/end.2006.0216.