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目的:通过与常规留置肾造瘘管的微创经皮肾镜取石术(mini-percutaneous nephrolithotomy,MPCNL)的效果比较,评价不置肾造瘘管的MPCNL(tubeless MPCNL)的临床价值。方法:选择2003年1月～2009年7月收治的上尿路结石患者345例,115例行tubeless MPCNL(A组),230例行常规留置肾造瘘管的MPCNL(B组)。并比较两组患者的手术时间、术中出血量、结石清除率、术后对镇痛药的需求、住院天数、并发症和医疗费用等指标。结果:A组均获得成功,其中11例行完全无管化的MPCNL(不留置肾造瘘管和双J管),13例行双侧同期tubeless MPCNL。其结石大小、手术时间、结石清除率、平均失血量及并发症发生率等与B组相当(P>0.05),但术后疼痛评分、镇痛药的需求、医疗费用及住院时间等均优于B组(P<0.05)。结论:对有适应证的上尿路结石患者行tubeless MPCNL安全、可行,部分患者还可行完全无管化的MPCNL。与常规留置肾造瘘管的MPCNL相比,tubeless MPCNL术后疼痛轻,恢复快,费用低,住院时间短。
OBJECTIVE: To evaluate the clinical value of MPCNL without renal fistula by comparing it with conventional mini-percutaneous nephrolithotomy (MPCNL). Methods: From January 2003 to July 2009, 345 patients with upper urinary tract calculi, 115 patients underwent tubeless MPCNL (group A) and 230 patients underwent routine renal catheterization (MPCNL). The operation time, intraoperative blood loss, stone clearance rate, postoperative analgesic demand, hospitalization days, complications and medical expenses were compared between the two groups. Results: All the patients in group A were successful. Eleven patients underwent complete denervation of MPCNL without indwelling nephrostomy tube and double J tube. Thirteen patients underwent bilateral simultaneous tubeless MPCNL. The stone size, operation time, stone removal rate, mean blood loss and complication rate were similar to those in group B (P> 0.05), but postoperative pain score, demand for analgesics, medical expenses and hospital stay were all excellent In group B (P <0.05). CONCLUSIONS: Tubeless MPCNL is safe and feasible for patients with upper urinary tract calcifications, and some patients are also able to achieve complete dematerialization of MPCNL. Compared with conventional indwelling renal fistula MPCNL, tubeless MPCNL postoperative pain, rapid recovery, low cost, short hospital stay.