Objectives To assess the efficacy and safety of a haemostasis technique of percutaneous nephrolithotomy using a peel-away sheath and a catheter to stress and traction the nephrostomy tract.Methods This was a prospective randomized trial of patients who fulfilled the inclusion criteria that undergoing PCNL between October 2011 and may 2012 in xiangya hospital.The patients who using a peel-away sheath and a catheter were compared with a control group(mPCNL).The safety and efficacy of the new approach was evaluated by comparing Fever situation hemoglobin drop,transfusion requirement,postoperative pain and Posto-perative urinary leakage.the date were analyzed by SPSS.18.0.Results The operations of 113 randomly selected patients were successfully completed the by mPCNL,with 105 cases using the single channel gravel and 8 cases of using the double channel gravel.Difference in hematocrit drop between the experimental (7.8097 ± 3.2280g) and control groups (13.2223 ±3.5766g) was ststistically significant (by two independent samples T test,P ＜ 0.05).The experimental group mean hemorrhage time of 3.06 ± 1.085 days,in controls the mean hemorrhage time is 3.78 ± 1.009 days,the average length of hemorrhage time was in experimental than in the control group (by two independent samples T test,P ＜ 0.05).A total of 14 cases of postoperative fever,in which the experimental group and the control group with 7 cases in each group(the Wilcoxon rank test,P ＞ 0.05),no statistical difference was found between the postoperative fevers for both group.a total of 45 patients accompany with varying degrees of pain,26 cases in the experimental group and 19 cases in the control group(the Wilcoxon rank test,P ＞ 0.05),The differences in pain degrees between the two groups were not statistically significant.12 cases group accompany with urine leakaging in the experimental,14 cases accompany with urine leakaging in the control group (by chi-square test,P ＞ 0.05),leakage of urine was not significant different in two groups.Conclusions It is safe to use a peel-away sheath and a catheter to stress the nephrostomy tract.This new haemostasis technique is associated with less hemoglobin drop and did not increase other complications.%目的 观察mPCNL术后留置Peel-away鞘无缝压迫加气囊导尿管牵拉止血法的疗效,寻找对mPCNL术后出血有效的防治措施,为临床治疗提供参考.方法 收集2011年10月～2012年5月在中南大学湘雅医院泌尿外科应用mPCNL治疗上尿路结石且符合入选标准的患者资料进行随机分组对比研究.将所有病例随机分为:无缝压迫组(A组):采用Peel-away鞘无缝压迫加气囊导尿管牵拉.肾造瘘管组(B组):留置普通肾造瘘管.比较两组患者的术后漏尿情况、疼痛程度、发热情况,出血时间及术后出血量,重点比较术后出血量.采用SPSS18.0进行统计分析.结果 本课题随机选取的113例患者均使用mPCNL顺利完成了手术.其中经单一通道取石105例,8例采用了双通道碎石.A组平均出血量为7.8097±3.2280g,留置普通B组平均出血量为13.2223±3.5766g.经两独立样本T检验,P＜0.05,具有明显的统计学差异.A组平均出血时间为3.06±1.085d,留置普通B组平均出血时间为3.78±1.009d,经两独立样本T检验,P ＜0.05,差异有统计学意义.共计有14例在术后出现发热,其中A组和留置普通B组各7例,经Wilcoxon秩和检验,P＞0.05,统计差异不明显.术后共有45例患者存在不同程度的疼痛,其中A组26例,留置普通B组19例,经Wilcoxon秩和检验,P＞0.05,统计差异不明显.A组12例出现漏尿,留置普通B组14例出现漏尿,经x2检验,P＞0.05,统计差异不显著.结论 mPCNL术后留置Peel-away鞘无缝压迫加气囊导尿管牵拉能显著减少术后出血量,且不增加其他相关并发症的发生率,实验证实有效,临床观察可行.
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