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目的评价即刻二期不置肾造瘘管的微创经皮肾镜取石术(Instantly phase-Ⅱ tubeless MPCNL)的可行性、安全性及疗效。方法对54例上尿路结石行MCPNL,术后12～24h内在明确无需二次镜检、无明显血尿及尿路感染的情况下拔除肾造瘘管。研究结果与对照组即同一时期内行常规留置肾造瘘管的MPCNL及一期不置肾造瘘管的MPCNL(tubeless MPCNL)的患者资料进行比较。结果 54例成功施行即刻二期不置肾造瘘管的MPCNL。3组病例的年龄、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差异无显著性(P>0.05),一期tubeless MPCNL和即刻二期tubeless MPCNL组术后疼痛评分、镇痛药的需求及住院时间均显著低于常规MPCNL组,差异有显著性(P<0.05)。54例患者术后无明显尿外渗及尿路感染,穿刺通道愈合良好,随访无肾周尿囊肿形成。结论对有适应证的患者施行即刻二期tubeless MPCNL安全、可行、有效。较常规留置肾造瘘管MPCNL术后疼痛不适更轻微、恢复更快,还可降低一期tubeless MPCNL术后继发出血的风险。
Objective To evaluate the feasibility, safety and efficacy of Instantly phase-Ⅱ tubeless MPCNL without immediate renal fistula. Methods 54 cases of upper urinary tract stones were treated with MCPNL. Nephrostomy tube was removed within 12 ~ 24 hours after clear prescription without secondary microscopy and without obvious hematuria and urinary tract infection. The results were compared with those of the control group, MPCNL of routine indwelling renal fistula and MPCNL of the first stage without renal fistula. Results Fifty-four patients underwent MPCNL without immediate renal fistula. There was no significant difference in age, stone size, operation time, stone clearance rate, average blood loss and complication incidence between the three groups (P> 0.05). The postoperative pain scores of the first-phase tubeless MPCNL and second-phase tubeless MPCNL group, The demand for analgesics and hospital stay were significantly lower than the conventional MPCNL group, the difference was significant (P <0.05). 54 patients had no obvious postoperative urine extravasation and urinary tract infection, well puncture access, no perirenal cyst formation. Conclusion It is safe, feasible and effective to administer immediate second-phase tubeless MPCNL in patients with indications. More indwelling renal fistula MPCNL postoperative pain less mild, faster recovery, but also reduce the risk of secondary bleeding after a tubeless MPCNL surgery.