摘要目的 探讨留置输尿管外支架的微通道无管化经皮肾镜取石术(tubeless-PCNL)治疗输尿管上段结石的临床效果。方法 回顾性分析本院泌尿外科2012-2014年手术治疗的120例输尿管上段结石患者的临床诊治方法，其中采用传统PCNL手术治疗57例(传统组)、采用tubeless-PCNL手术治疗63例(tubeless-PCNL组)，统计分析2组患者的手术指标、术后康复及并发症指标的差异。结果 tubeless-PCNL组患者的手术时间(59.3±9.2)min、术后24 h VAS评分(2.40±0.81)分、镇痛剂使用率(6.4%)、住院时间(6.3±1.5)d均显著低于传统组患者的手术时间(62.4±8.9)min、术后24 h VAS评分(3.96±1.27)分、镇痛剂使用率(24.6%)、住院时间(7.6±1.8)d，差异具有统计学意义(P<0.05，P<0.01)。tubeless-PCNL组患者的肾周积液率(11.11%)、术后尿急率(3.2%)、血尿发生率(7.9%)、腰痛发生率(4.8%)均显著低于传统组患者，差异具有统计学意义(P<0.05)。结论 Tubeless-PCNL治疗输尿管上段结石具有手术时间短、术后恢复快、疼痛程度低、并发症率低的优势。
Abstract：Objective To explore the clinical effect of percutaneous renal lithotripsy (tubeless-PCNL) with a micro channel of indwelling ureteral stents on the treatment of ureteral calculi.Methods The clinical diagnosis and treatment of 120 cases of ureteral calculi patients were analyzed retrospectively in a hospital between 2012 and 2014. Among these cases, 57 received traditional PCNL surgery (traditional group), and 63 received tubeless-PCNL treatment (tubeless-PCNL group). Indications for surgery, postoperative recovery and complications were statistically analyzed between the two groups.Results The operation time(59.3?.2)min, postoperative 24h VAS score(2.40?.81),analgesic usage(6.35%),length of hospital stay(6.3?.5)d of patients in tubeless-PCNL group were significantly lower than those in traditional group, and the difference was statistically significant (P<0.05,P<0.01). There was no significant difference in hemoglobin (P>0.05), HCT or fever between the two groups . The incidence of perirenal effusion(11.1%),postoperative urgent urination(3.2%),hematuria(7.9%),low back pain(4.8%) of patients in tubeless-PCNL group was significantly lower than in traditional group, and the difference was statistically significant(P< 0.05).Conclusion Tubeless-PCNL treatment of upper ureteral calculi has the advantages of a short operation time, quick recovery, low degree of pain and low complication rate.
梁荣兴，郭建军，袁鹏飞，蔡恒. Tubeless-PCNL处理输尿管上段结石的有效性和安全性[J]. 解放军预防医学杂志, 2016, 34(4): 510-512.
LIANG Rongxing, GUO Jianjun, YUAN Pengfei, CAI Heng. Effectiveness and Safety of Tubeless-PCNL in Treatment of Upper Ureteral Calculi. Journal of Preventive Medicine of Chinese People's Liberation Army, 2016, 34(4): 510-512.
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