目的：探讨无管化微造瘘经皮肾镜取石术治疗肾及输尿管上段结石的有效性及安全性。方法选取2013年12月至2015年6月本院收治的90例肾及输尿管上段结石患者为研究对象，按照治疗方法不同将其分为观察组（未放置肾造瘘管）和对照组（留置 F14肾造瘘管），每组各45例。两组患者均采取经皮肾镜取石术治疗，比较两组患者平均手术时间、平均住院时间、术中平均出血量、输血率、治疗费用、结石清除率、术后并发症发生情况。结果两组患者结石清除率、平均手术时间、术中平均出血量、输血率、术后并发症发生率比较差异均无显著性（P ＞0.05）；观察组患者平均住院时间、治疗费用、镇痛药物需求比例、术后疼痛程度、恢复正常生活时间与对照组比较差异均具有显著性（P ＜0.05）。结论与留置肾造瘘管相比，无管化微造瘘经皮肾镜取石术治疗肾及输尿管上段结石在结石清除率等方面效果相当，但其具有减轻患者术后疼痛，减少镇痛药物用量，促进患者康复，节约医疗费用等优点，值得临床推广应用。%Objective To explore the efficacy and safety of tubeless minimally invasive percutaneous nephrolitotomy in the treatment of renal and upper ureteral calculi. Method 90 cases of renal and upper ureteral calculi patients in our hospital from December 2013 to June 2015 were divided into observation group (unplaced nephrostomy drainage) and control group (with an indwelling F14 nephrostomy drainage), 45 cases in each group. The two groups patients were all implemented percutaneous nephrolitotomy treatment. The mean operation time, mean length of stay, intraoperative mean blood loss, blood transfusion rates, the costs of treatment, stone clearance rates and incidence of postoperative complications were compared between the two groups. Result There were no significant in differences stone clearance rate, mean operation time, intraoperative mean blood loss, blood transfusion rate and postoperative complications between the two groups (P > 0.05); but there were significant differences in mean length of stay, cost of treatment, analgesic demand, postoperative pain degree, restoring normal life time between the two groups (P < 0.05). Conclusion Both indwelling nephrostomy drainage and tubeless minimally invasive percutaneous nephrolitotomy can effectively clear stones, postoperative pain and the dosage of analgesic can be reduced significantly with tubeless minimally invasive percutaneous nephrolitotomy, which should be widely applied.
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