Comparative study of minimally invasive percutaneous nephrolithotomy in the treatment of nephrolithiasis with indwelling nephrostomy tube or tubeless

doi:10.3877/cma.j.issn.1674-3253.2020.01.009

Abstract

Abstract:

Objective

To explore the clinical application of tubeless minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of renal calculi.

Methods

Clinical data of patients with renal calculi admitted to our hospital from May 2015 to January 2018 were retrospectively analyzed. In the tubeless group, the mean stone size of 58 cases was (3.1±1.6) cm (range: 2.2-4.8 cm). Percutaneous renal access was established via 16 F catheter and 8/9.8 F ureteroscopic lithotripsy was performed. After complete removal of the residual stones, a guide wire was retained into the ureter, no obvious active bleeding was found after the withdrawal of peel-away sheath, and tubeless MPCNL was performed. In the tube-retaining group, the mean stone size of 50 patients was (3.2±1.5) cm (range: 2.1-5.0 cm). The operation method was the same as that in the tubeless group. Pelvic fistula tube was retained after operation.

Results

Preoperative data did not significantly differ between two groups. All patients in two groups successfully received PCNL. The operation time was (72±21) min (range:40-98 min) in the tubeless group and (74±21) min (range:46-100 min) in the tube-retaining group. Blood routine examination was conducted at postoperative 1 d. Blood transfusion was not required in both groups. The stone removal rates were 98.3% (57/58) and 98% (49/50) in two groups. In the tubeless group, the length of hospital stay was (2.2±0.2) d and (4.3±0.8) d in the tube-retaining group. In the tubeless group, 21 patients developed fever of > 38.5℃ after operation, 6 of them (10.3%) were improved after antipyretic therapy and 15 patients (25.9%) were mitigated after antibiotic therapy. One patient suffered from abdominal distension caused by urinary extravasation after operation. In the tube-retaining group, 18 patients had fever of > 38.5℃, 5 of them (10%) were improved after antipyretic treatment and 13 patients (26%) were alleviated after antibiotic treatment. No other serious complications occurred in other patients.

Conclusion

Tubeless MPCNL is safe and efficacious treatment of renal calculi, which can shorten the length of hospital stay.

Key words: Renal stone, Percutaneous nephrolithotomy, Tubeless, Retrospective trial

Guangcheng Ge, Zhongxing Li, Rui Feng, Xing Wang, Yuejun Jia. Comparative study of minimally invasive percutaneous nephrolithotomy in the treatment of nephrolithiasis with indwelling nephrostomy tube or tubeless[J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(01): 36-39.

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Figures/Tables 3

References 18

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组别	例数	性别（例）		年龄（岁，±s）	伴轻度肾积水（例）	结石负荷（cm，±s）	结石位置（例）
组别	例数	男	女	年龄（岁，±s）	伴轻度肾积水（例）	结石负荷（cm，±s）	上盏	肾盂	下盏	多部位
无管组	58	33	25	42±8	34	3.1±1.6	9	8	13	28
留管组	50	27	23	43±8	33	3.2±1.5	6	16	11	17
统计值	?	χ²=0.091		t=1.760	χ²=0.631	t=0.365	χ²=0.278	χ²=0.028	χ²=1.623	χ²=2.253
P值	?	0.763		0.081	0.431	0.716	0.598	0.867	0.203	0.133

组别	例数	性别（例）		年龄（岁，±s）	伴轻度肾积水（例）	结石负荷（cm，±s）	结石位置（例）
组别	例数	男	女	年龄（岁，±s）	伴轻度肾积水（例）	结石负荷（cm，±s）	上盏	肾盂	下盏	多部位
无管组	58	33	25	42±8	34	3.1±1.6	9	8	13	28
留管组	50	27	23	43±8	33	3.2±1.5	6	16	11	17
统计值	?	χ²=0.091		t=1.760	χ²=0.631	t=0.365	χ²=0.278	χ²=0.028	χ²=1.623	χ²=2.253
P值	?	0.763		0.081	0.431	0.716	0.598	0.867	0.203	0.133

?	例数	手术时间（min，±s）	手术前后Hb差值（g/L，±s）	手术前后降钙素原差值（μg/L，±s）	术后住院时间（d，±s）	结石清除率[例（%）]
无管组	58	72±21	7.2±2.8	0.25±0.04	2.2±0.2	57（98.3）
留管组	50	74±21	6.9±2.6	0.24±0.08	4.3±0.8	49（98.0）
统计值	?	t=1.207	t=2.269	t=1.170	t=29.931	χ²=0.011
P值	?	0.230	0.789	0.245	<0.001	0.916

?	例数	手术时间（min，±s）	手术前后Hb差值（g/L，±s）	手术前后降钙素原差值（μg/L，±s）	术后住院时间（d，±s）	结石清除率[例（%）]
无管组	58	72±21	7.2±2.8	0.25±0.04	2.2±0.2	57（98.3）
留管组	50	74±21	6.9±2.6	0.24±0.08	4.3±0.8	49（98.0）
统计值	?	t=1.207	t=2.269	t=1.170	t=29.931	χ²=0.011
P值	?	0.230	0.789	0.245	<0.001	0.916

组别	例数	Ⅰ级			Ⅱ级	Ⅲ级
组别	例数	术后疼痛	呕吐	发热需要退热治疗	感染需要抗生素治疗	尿外渗	肾周血肿
无管组	58	14（24.1）	12（20.7）	6（10.3）	15（25.9）	1（1.7）	1（1.7）
留管组	50	49（98.0）	9（18.0）	5（10.0）	13（26.0）	0（0）	2（4.0）
χ²值	?	60.27	0.124	0.003	0.000	-	-
P值	?	<0.001	0.725	0.953	0.987	0.351	0.473

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