目的：通过比较无管化微创经皮肾手术与普通微创经皮肾手术(minimally invasive percutaneous nephrolithotomy，mPCNL)的临床结果来评价无管化mPCNL的优缺点。方法：从2013年6月至2014年6月，172个肾结石患者行了mPCNL(组1，132例)或无管化mPCNL(组2，40例)，我们对这些患者分组进行了回顾性分析。术者在手术结束时按以下标准决定无管化：1)手术过程中没有严重的出血或集合系统穿孔；2)不超过1个穿刺通道；3)没有残留结石需要2期取石。鹿角形结石和解剖异常也被排除出无管化mPCNL组。我们对两组患者及结石的基本特征、术中及术后的参数进行了比较。结果：两组患者的基本特征无明显差别。组1和组2的平均结石负荷是(522.2±340.1 vs. 499.3±325.6 mm2，P=0.478)。两组的住院天数(7.72±3.58 vs. 5.10±2.88 days，P=0.001)和术后疼痛的视觉评分(day 0：P<0.001；day 1：P=0.002)存在显著性差异。镇痛药物的使用率在两组间无明显差异。结论：使用无管化mPCNL治疗肾结石比普通mPCNL有更少疼痛、更短住院天数等优势。
Tubeless Versus Common Minimally Invasive Percutaneous Nephrolithotomy for Renal Stones: Analysis of Clinical Outcomes
Objective: To evaluate the safety of a tubeless minimally invasive percutaneous nephrolithotomy (mPCNL) by comparing the clinical outcomes between common mPCNL and tubeless PCNL for renal stones. Methods: From June 2013 to June 2014, a total of 172 patients with renal stones who underwent mPCNL (group 1, 132 cases) or tubeless mPCNL (group 2, 40 cases) were retrospectively evaluated by group. The decision to perform a tubeless mPCNL was made at the end of the procedures depending on the surgeon's preference and according to the following inclusion criteria: 1)no serious bleeding or perforation in the collecting system during the procedure; 2)patients with no more than one access; and 3)no residual stone burden needing a second-stage nephroscopy. Staghorn stones and anatomic anomalies were not considered as exclusion criteria for tubeless mPCNL. Patient and stone characteristics, intraoperative and postoperative parameters were compared between the two groups. Results: There were no significant differences in the patient demographics between groups. Mean stone burden was (522.2±340.1) mm2 in group 1 vs. (499.3±325.6) mm2 in group 2 (P=0.405). Length of hospital stay (7.72±3.58 vs. 5.10± 2.88 days, P<0.001), postoperative pain scores using a visual analog scale (day 0: P<0.001; day 1: P=0.002) for group 1 vs. group 2 showed significant differences. The analgesic demand rate was not significant difference between groups. Conclusion: Treating renal stones with tubeless mPCNL has advantages over common mPCNL, including less pain and shorter hospital stay.