摘要
目的：观察经皮肾镜术后肾造瘘管与导尿管不同拔除顺序的术后并发症发生情况。方法我科2013年1月~2014年2月，双侧或单侧鹿角形肾结石患者，建立 F22标准经皮肾镜手术通道，标准肾镜下四代超声气压弹道（EMS）碎石，选取不能耐受留置导尿管而先于肾造瘘管拔除者25例作为观察组，术后1~3 d拔除导尿管，复查腹部平片（KUB）或双肾 CT 后再行拔除肾造瘘管。选取45例同期病例作为对照组，术后3~5 d 先拔除肾造瘘管，1~2 d 后再拔除导尿管。均留置双 J 管4~6周，术后随访2个月。结果观察组25例平均住院（8.88±1.09）d，拔管后发热8例（33.33%），尿外渗4例（15.56%），再次导尿8例（33.33%），肾周穿刺引流3例（8.89%）。与对照组比较，观察组住院天数和拔管后发热、尿外渗、再次导尿及肾周穿刺引流例数均增加或上升（P ﹤0.05），但未影响迟发性出血的发生率（P ﹥0.05）。2组随访2个月肾功能损害无统计学差异（P ﹥0.05）。结论经皮肾镜术后先拔除肾造瘘管后再行拔除导尿管是安全、可行的。
Objective To compare postoperative complications caused by order of removing nephrostomy tube and catheter after percutaneous nephrolithotomy. Methods Patients with bilateral or unilateral staghorn calculi who underwent F22 standard percutaneous nephrolithotomy（ PCNL）,standard fourth generation Swiss Lithoclast Master （EMS）in our hospital from Jan. 2013 to Feb. 2014 were analyzed retrospectively. 25 patients who were intolerant to the urethral catheter were enrolled to the observation group. Catheter was removed 1 ~ 3 days after operation and ne-phrostomy tube was removed after a evaluation by KUB or renal CT. 45 patients in the same period served as the con-trol group. Nephrostomy tube was removed 3 ~ 5 days after operation and catheter was removed 1 ~ 2 days later. Double J tube was kept for 4 ~ 6 weeks and all patients were followed up for 2 months. Results In the observation group,the averaged length of stay was（8. 88± 1. 09）days,fever after extubation was observed in 8 cases（33. 33% ）,urinary ex-travasation was observed in 4 cases（15. 56% ）,repeated catheterization occurred in 8 cases（33. 33% ）,perinephric puncture drainage was observed in 3 cases（8. 89% ）. Hospital stay,incidence of fever after extubation,urinary extrav-asation,repeated catheterization,perinephric puncture drainage were significantly increased in observation group（P ﹤0. 05）. However,the incidence of delayed bleeding was not affected（P ﹥ 0. 05）. There was no significant difference in renal dysfunction after 2 months follow - up between the two groups（P ﹥ 0. 05）. Conclusion It is safe and feasible to remove nephrostomy tube first after percutaneous nephrolithotomy.
出处
《医学新知》
CAS
2014年第3期161-163,167,共4页
New Medicine
关键词
经皮肾镜
肾造瘘管
导尿管
Percutaneous nephrolithotomy
Nephrostomy tube
Catheter
