目的 评估经12肋下完全无管化经皮肾镜碎石术治疗肾上盏结石的疗效和安全性.方法 2007年10月至2012年1月,80例患者入选试验对照观察.完全无管化过程(无肾造瘘管、无双“J”管)40例(无管化组),另40例(标准组)进行标准经皮肾碎石取石术.研究比较2组并发症的发生率、住院时间、输血率、无结石率和止痛药的使用以及恢复正常活动.结果 平均结石直径无管化组为(2.67±0.47) em,标准组为(2.77±0.52) cm.无管化组平均住院日为(5.5±1.6)d,标准组为(10.6±1.9)d,P＜0.05.无管化组平均止痛药的使用为(9.5±3.96) mg,标准组为(16.6±6.16) mg的吗啡(P＜0.05).无管化组病人恢复正常活动为(12±4.7)d,标准组为(25.6±5.4)d,P＜0.05.手术时间、输血率、并发症、结石清除率2组差异无统计学意义.研究中无重大并发症发生.结论 经12肋下完全无管化经皮肾镜碎石术治疗肾上盏结石能减少患者的住院天数、止痛药的使用并且能加快恢复正常活动,可以被接受和具有显著的成本效益.%Objective To assess the outcome and safety of the totally tubeless percutaneous nephrolithotomy (PCNL) from subcostal access in patients with upper calyx renal stone. Methods Eighty patients with upper calyx renal stone were enrolled in a randomized clinical trial from October 2007 to January 2012. The totally tubeless procedure was performed on 40 patients; another 40 patients underwent standard PCNL. The incidence of complications, hospital stay, transfusion rate, stone free rate, and analgesics use as well as return to normal activity were compared during a 1-month study period. Results The mean stone burden was (2.67 ± 0.47) cm in totally tubeless PCNL group vs (2.77 ±0.52) cm in standard PCNL group. Hospitalization averaged 5.5 ± 1.6 vs 10.6 ± 1.9 days (P < 0.05) , and the average analgesics use was (9.5 ±3.96) mg vs ( 16.6 ±6.16) mg of morphine, respectively (P < 0.05). The patients returned to normal activity in 12 ±4.7 days in totally tubeless PCNL group vs 25.6 ± 5.4 in standard PCNL group (P<0.05). Operative time, transfusion rate, complications, and the overall stone-free rate were not different signi cantly, and no major complications were found in the study as well. Conclusions Totally tubeless PCNL for the upper calyx renal stone from subcostal access can reduce the hospital stay and analgesics use and accelerate return to normal activity. It can be considered as an accepted and cost-bene cial procedure for upper pole renal stones.
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