无肾造瘘管经皮肾镜取石术的治疗体会

Experience in treatment of percutaneous nephrolithotomy without fistula

摘要:

目的 评价无肾造瘘管经皮肾镜取石术（PCNL）的临床疗效和可行性。方法 选取2016年1月－2018年12月该院泌尿系结石患者96例，根据PCNL术中肾造瘘管留置情况，48例行无肾造瘘管PCNL（观察组），48例行常规留置肾造瘘管PCNL（对照组）。比较两组患者手术时间、住院时间、结石清除率、术后恢复情况和并发症等。结果 96例患者均顺利完成手术。观察组患者术后住院时间、语言评价量表（VDS）、疼痛视觉模拟评分（VAS）、住院费用、尿漏时间、术后发热时间、术后恢复时间和恢复正常工作时间均明显少于对照组，两组比较，差异有统计学意义（P < 0.05）；两组患者手术时间和术后血红蛋白下降值比较，差异无统计学意义（P > 0.05）。结论 无肾造瘘管PCNL较常规留置肾造瘘管PCNL具有术后疼痛轻、恢复快、住院时间短和经济负担较低等优势，是安全、可行、有效的，值得临床推广。

Abstract:

Objective To evaluate the clinical efficacy and feasibility of percutaneous nephrolithotomy percutaneous nephrolithotomy without fistula.Methods 96 patients with urinary calculi were selected from January 2016 to December 2018. According to the condition of renal fistula indwelling in PCNL, 48 patients were treated by PCNL without fistula (observation group) and 48 patients were treated by PCNL with fistula (control group). The operation time, hospitalization time, stone clearance rate, postoperative recovery and complications were compared between the two groups.Results All the 96 patients completed the operation successfully. The time of hospitalization, VDS and VAS pain score, hospitalization expenses, urinary leakage time, fever time after operation, recovery time after operation and return to normal working time of patients in observation group were significantly lower than those in control group (P < 0.05). There were no significant difference in operation time and after operative hemoglobin decreased value between the two groups (P > 0.05).Conclusion PCNL without fistula has the advantages of less pain after operation, faster recovery, shorter hospitalization time and less economic burden than PCNL with fistula. It is safe, feasible and effective, worth popularizing.