| Objective: To assess the advantages and safety feasibility of partially tubeless percutaneous nephrolithotomy,and to provide more evidence-based evidence for the promotion of partially tubeless percutaneous nephrolithotomy and the selection of indications.Methods: The clinical medical records of patients with upper urinary calculi who underwent percutaneous nephrolithotomy(PCNL)in Yijishan Hospital of Wannan Medical College from June 2015 to June 2018 were collected and classified into standard group and partially tubeless group.Patients in partially tubeless group were treated with insertion of a F5 ureteral double pigtail stent without placement of nephrostomy tube after operation,while both double pigtail stent and F18 nephrostomy tube were routinely placed in patients in standard group.After screening,a total of 77 patients were included in the study,including 35 patients in standard group and 42 patients in partially tubeless group.The general data of gender,age,Body Mass Index(BMI),stone load,distribution characteristics and past medical history of the two groups were counted,as well as the operation time,postoperative hospital stay,postoperative hospital cost,off-bed time,and visual analogue scale(VAS)in the first day after operation,use of painkillers,decreased hemoglobin,rate of postoperative blood transfusion,duration of macroscopic hematuria,hydroperinephrosis,perirenal hematoma,residual calculus,urinary extravasation,and incidence of infection.The above data were analyzed by SPSS20.0 statistical software,and the differences were compared.Results: There were no statistically significant differences between standard group and partially tubeless group in terms of gender,age,BMI,stone load,distribution characteristics,and past medical history(P>0.05).The two groups were comparable.The operation time of standard group was 58.71±11.89 minutes,which was slightly more than that of partially tubeless group(53.64±12.63 minutes),but the difference was not statistically significant(P=0.076>0.05).The off-bed time in standard group was 5.74±0.82 days,and the off-bed time in partially tubeless group was 5.31±0.64 days.There was significant difference between them(P=0.011<0.05).The postoperative hospital stay and postoperative hospital cost were significantly lower in partially tubeless group than in standard group [(6.31±0.75 days)vs(7.74±0.95 days),P=0.000<0.05;(3754.79±624.07 yuan)vs(4147.31±354.26 yuan),P=0.001<0.05].In partially tubeless group,the VAS was 2.81±0.92 one day after operation,and 10 patients used painkillers.In standard group,the VAS was 4.29±1.13,and 17 patients used painkillers.The difference was statistically significant(P=0.000<0.05;P=0.023<0.05).There were no significant differences in decreased hemoglobin,duration of postoperative macroscopic hematuria,rate of postoperative blood transfusion,hydroperinephrosis,perirenal hematoma,and residual calculus(P>0.05).Urinary extravasation occurred in 8 patients in standard group,which was far more than in 2 patients in partially tubeless group(P=0.044<0.05).In standard group,9 patients had obvious fever and 10 patients had abnormal procalcitonin(PCT).In partially tubeless group,3 patients had obvious fever and 4 patients had abnormal PCT.And the difference was statistically significant(P=0.025<0.05;P=0.031<0.05).Conclusion: For eligible patients,PCNL without placement of nephrostomy tube can not only significantly reduce postoperative pain,shorten the duration of hospitalization,decrease hospitalization costs,allow patients to get out of bed early after surgery,but also reduce the incidence of urinary extravasation and infection,and does not increase the risk of bleeding and perirenal exudation.Compared with standard PCNL,partially tubeless PCNL is also safe and feasible,and has certain advantages.And its indications can be appropriately relaxed. |
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