554例部分无管化mPCNL临床分析
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摘要
目的总结部分无管化mPCNL经验.方法回顾性分析2010年1月至2016年12月多中心部分无管化mPCNL手术经验.7 a间共完成1 320例mPCNL手术,其中部分无管化mPCNL554例,标准化mPCNL766例.除外手术时间大于2 h及各种原因被迫中止手术的85例,共681例标准化mPCNL与部分无管化mPCNL进行比较.结果随着部分无管化手术指征逐渐放宽,部分无管化手术率增加,并发症并无增加,2016年部分无管化mPCNL率达84%.与标准化mPCNL比较,二者手术净石率、平均血红蛋白下降、输血率、术后发热率无显著差异.术后止痛剂应用率、术后住院天数有显著差异,分别为5%:21%(P=0.001)和2.5:4.5 d(P=0.001).术后出血相关并发症发生率无管化与标准组分别为1.1%和2.5%,无显著性差异.部分无管化组发生1例尿外渗,1例胸膜损伤出血,分别予肾周引流、抗生素治疗及开放探查、胸腔引流后顺利出院.结论与标准mPCNL相比,部分无管化mPCNL明显增加患者术后的舒适性,缩短住院时间,术后相关并发症无增加,是安全可行的手术方式.
Objective To summarize the experience of partial tubeless mPCNL. Methods A retrospective analysis of partial tubeless mPCNL surgery experience from January 2010 to December 2016. Atotal of 1320 patients underwent mPCNL surgery in these 7 years.Out fo those 1320 patients, 554 patients underwent partial tubeless mPCNL,766 patients underwent standard mPCNL,and 85 exception cases of standard mPCNL were forced to abort surgery due to maximum surgery time of 2 hours and different complications such as bleeding, infections and etc,so total of 681 patients with standard mPCNL were compared with partial tubeless mPCNL.Re s ults The rate of partialtubeless mPCNL has increased by 84% in 2016, with an indication of tubeless mPCNL being extended,while the complication rate showed no increase. Compared with the standard mPCNL, there was no significant difference between the two groups in the rate of stone removal, drop in mean hemoglobin, blood transfusion and postoperative fever. There were significant differences in postoperative analgesic use rate(5%:21%, P = 0.001)and hospitalization stay(2.5:4.5 d,P = 0.001). The rate of postoperative bleeding complications in partial tubeless group and standard group is 1.1% and 2.5%respectively, but difference is not statistically significant. There were1 cases of urinary extravasations in the partial tubeless group which was treated by perirenal drainage, antibiotic treatment, and 1 cases of pleural injury, which were treated by open exploration, and chest tube placement.Conclus ion In compared to standard mPCNL partial tubeless mPCNL significantly increased patients postoperative comfort, shorten hospital stay, and no complications increased.Partial tubless mPCNL is a safe and practicableprocedure.
Objective To summarize the experience of partial tubeless mPCNL. Methods A retrospective analysis of partial tubeless mPCNL surgery experience from January 2010 to December 2016. Atotal of 1320 patients underwent mPCNL surgery in these 7 years.Out fo those 1320 patients, 554 patients underwent partial tubeless mPCNL,766 patients underwent standard mPCNL,and 85 exception cases of standard mPCNL were forced to abort surgery due to maximum surgery time of 2 hours and different complications such as bleeding, infections and etc,so total of 681 patients with standard mPCNL were compared with partial tubeless mPCNL.Re s ults The rate of partialtubeless mPCNL has increased by 84% in 2016, with an indication of tubeless mPCNL being extended,while the complication rate showed no increase. Compared with the standard mPCNL, there was no significant difference between the two groups in the rate of stone removal, drop in mean hemoglobin, blood transfusion and postoperative fever. There were significant differences in postoperative analgesic use rate(5%:21%, P = 0.001)and hospitalization stay(2.5:4.5 d,P = 0.001). The rate of postoperative bleeding complications in partial tubeless group and standard group is 1.1% and 2.5%respectively, but difference is not statistically significant. There were1 cases of urinary extravasations in the partial tubeless group which was treated by perirenal drainage, antibiotic treatment, and 1 cases of pleural injury, which were treated by open exploration, and chest tube placement.Conclus ion In compared to standard mPCNL partial tubeless mPCNL significantly increased patients postoperative comfort, shorten hospital stay, and no complications increased.Partial tubless mPCNL is a safe and practicableprocedure.
引文
[1]BELLMAN G C,DAVUDIFF R,CANDELA J,et al.Tubeless percutaneous renal surgery[J].J Urol,1997,157(5):1578-1582
[2]KEOGHANE S R,CETTI R J,ROGERS A E,et al.Blood transfusion,emblisasion and nephrectomy after percutaneous nephrolithtomy(PCNL)[J].Bju International,2013,111(4):628.
[3]MARAWAN M,TAYEB E I,JOHN J K,et al.Vascular complications after percutaneous nephrolithotomy:10 years of experience[J].Urology,2015,85(4):777-781.
[4]ELNAHAS A R.Post percutaneousnephrolithotomy extensive hemorrhage:A studyof risk factors[J].J Urol,2007,177(2):576-579.
[5]RICHSTONE L E E,ERNESTO RIGGIO,MICHAEL C O,et al.Hemorrhage following percutaneous renal surgery:characterization of angiographic finding[J].J Endourol Ogy,2008,22(6):1129-1135.
[6]熊六林,黄小波,叶俊雄,等.经皮肾镜术后肾脏严重出血特点及选择性介入栓塞的时机选择[J].北京大学学报(医学版),2010,42(4):465-468.
[7]陈富坤,王家平.超选择性肾动脉栓塞治疗经皮肾镜取石术后肾出血的临床研究[J].昆明医科大学学报,2014,35(3):71-73.
[8]RASTINEHAD A R,ANDONIAN S,SMITH A D,et al.Management of Hemorrhagic Complications Associated with Percutaneous Nephrolithotomy[J].J Endourol,2009,23(10):1763-1767.
[9]BRANDENBURG V M,FRANK R D,RIEHL J.Color-coded duplex sonography study of arteriovenousfistulae and pseudoaneurysms complicatingpercutaneous renal allograft biopsy[J].Clin Nephrol,2002,58(6):398-404.
[10]PREDA A,VAN DIJK L C,VAN OOSTAIJEN J A,et al.Complication rate anddiagnostic yield of 515 consecutiveultrasoundguidedbiopsies of renal allografts and nativekidneys using a 14 gauge biopsy gun[J].Eur Radiol,2003,13(3):527-530.
[11]COPE C,ZEIT R M.Pseudoaneurysms after Nephrostomy[J].AJR,1982,139(2):255-261.
[12]吉正国,陈永骞,刘志,等.微创经皮肾镜取石术并发严重出血防治体会[J].中华损伤与修复杂志(电子版),2014,9(5):517-518.
[13]李茂胤,王德娟,邱剑光,等.无管化经皮肾镜碎石取石术治疗鹿角形肾结石[J].中华腔镜泌尿外科杂志(电子版),2016,10(1):40-43.
[14]SHAH H,KHANDKAR A,SODHA H,et al.Tubeless percutaneous nephrolithotomy:3 yearsof experience with 454patients[J].Bju International,2009,104(6):840-846.
[15]SHOMA A M,ELSHA A M.Nephrostomy tube placement after percutaneous nephrolithotomy:critical evaluation through a prospective randomized study[J].Urology,2012,79(4):771-776.
[16]COGAINM R D,KRAMBECKA E.Advances in tubeless percutaneous nephrolithotomy and patient selection:An update[J].Curr Uro Rep,2013,14(2):130-137.
[2]KEOGHANE S R,CETTI R J,ROGERS A E,et al.Blood transfusion,emblisasion and nephrectomy after percutaneous nephrolithtomy(PCNL)[J].Bju International,2013,111(4):628.
[3]MARAWAN M,TAYEB E I,JOHN J K,et al.Vascular complications after percutaneous nephrolithotomy:10 years of experience[J].Urology,2015,85(4):777-781.
[4]ELNAHAS A R.Post percutaneousnephrolithotomy extensive hemorrhage:A studyof risk factors[J].J Urol,2007,177(2):576-579.
[5]RICHSTONE L E E,ERNESTO RIGGIO,MICHAEL C O,et al.Hemorrhage following percutaneous renal surgery:characterization of angiographic finding[J].J Endourol Ogy,2008,22(6):1129-1135.
[6]熊六林,黄小波,叶俊雄,等.经皮肾镜术后肾脏严重出血特点及选择性介入栓塞的时机选择[J].北京大学学报(医学版),2010,42(4):465-468.
[7]陈富坤,王家平.超选择性肾动脉栓塞治疗经皮肾镜取石术后肾出血的临床研究[J].昆明医科大学学报,2014,35(3):71-73.
[8]RASTINEHAD A R,ANDONIAN S,SMITH A D,et al.Management of Hemorrhagic Complications Associated with Percutaneous Nephrolithotomy[J].J Endourol,2009,23(10):1763-1767.
[9]BRANDENBURG V M,FRANK R D,RIEHL J.Color-coded duplex sonography study of arteriovenousfistulae and pseudoaneurysms complicatingpercutaneous renal allograft biopsy[J].Clin Nephrol,2002,58(6):398-404.
[10]PREDA A,VAN DIJK L C,VAN OOSTAIJEN J A,et al.Complication rate anddiagnostic yield of 515 consecutiveultrasoundguidedbiopsies of renal allografts and nativekidneys using a 14 gauge biopsy gun[J].Eur Radiol,2003,13(3):527-530.
[11]COPE C,ZEIT R M.Pseudoaneurysms after Nephrostomy[J].AJR,1982,139(2):255-261.
[12]吉正国,陈永骞,刘志,等.微创经皮肾镜取石术并发严重出血防治体会[J].中华损伤与修复杂志(电子版),2014,9(5):517-518.
[13]李茂胤,王德娟,邱剑光,等.无管化经皮肾镜碎石取石术治疗鹿角形肾结石[J].中华腔镜泌尿外科杂志(电子版),2016,10(1):40-43.
[14]SHAH H,KHANDKAR A,SODHA H,et al.Tubeless percutaneous nephrolithotomy:3 yearsof experience with 454patients[J].Bju International,2009,104(6):840-846.
[15]SHOMA A M,ELSHA A M.Nephrostomy tube placement after percutaneous nephrolithotomy:critical evaluation through a prospective randomized study[J].Urology,2012,79(4):771-776.
[16]COGAINM R D,KRAMBECKA E.Advances in tubeless percutaneous nephrolithotomy and patient selection:An update[J].Curr Uro Rep,2013,14(2):130-137.