无管化经皮肾镜取石术治疗复杂性肾结石及其适应证探讨-东南大学学报医学版

无管化经皮肾镜取石术治疗复杂性肾结石及其适应证探讨

单位：皖南医学院弋矶山医院泌尿外科, 安徽芜湖 241001

分类号：R692.4

出版年·卷·期（页码）：2019·38·第四期（623-627）

摘要：

目的：探讨无管化经皮肾镜取石术（percutaneous nephrolithotomy，PCNL）治疗复杂性肾结石的可行性及其适应证。方法：选择2016年5月至2018年7月40例行无管化PCNL和32例行常规PCNL的复杂性肾结石患者，比较两组患者术前及术后相应指标。结果：两组手术时间、肉眼血尿天数、血红蛋白下降值、输血率、残石率、肾周积液/血肿发生率方面差异均无统计学意义（均P>0.05），而无管化组在术后下床时间、术后住院时间、住院费用、术后1 d疼痛模拟评分、止痛药使用率、尿外渗和感染的发生率等方面均优于常规组（均P<0.05）。结论：对于大负荷、积水重以及鹿角形结石等复杂性肾结石，无管化PCNL同样安全可行，而且具有一定优势，其适应证可以适当放宽。

Objective: To assess the feasibility and indications of tubeless percutaneous nephrolithotomy (PCNL) in the treatment of complicated renal calculi. Methods: Forty cases undergoing tubeless PCNL and another 32 receiving conventional PCNL were included from May 2016 to July 2018. Then the pre-and postoperative indexes of the two groups were compared. Results: The difference was insignificant between the two groups in terms of the operative time, duration of macroscopic haematuria, decrease of Hb, and rate of blood transfusion, residual calculus, hydroperinephrosis and perirenal hematoma. However, patients treated with tubeless PCNL had superiority over those undergoing conventional PCNL in off-bed time, postoperative hospital stay, hospital cost, VAS on the first day after operation, rate of using painkillers, incidence of urinary extravasation and infection. Conclusion: For complicated renal calculi such as heavy load, severe hydronephrosis and staghorn calculi, tubeless PCNL is equally safe and feasible, and has some advantages. The indications can be relaxed appropriately.

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