摘要
目的:探讨日间手术模式下行超细经皮肾镜取石术的可行性以及安全性。方法:回顾性分析2015年6月-2019年3月采用超细经皮肾镜取石术治疗的肾结石或输尿管上段结石患者的临床资料。其中日间手术组287例,住院手术组75例,两组性别、年龄、结石大小、肾积水程度比较差异无统计学意义。比较两组结石清除率、手术时间、住院天数、住院费用、并发症发生情况以及再入院率等指标。结果:日间手术组与住院手术组平均住院天数分别为(1.2±0.8)d、(2.6±0.9)d;日间手术组与住院手术组平均住院费用分别为(12623.8±3141.4)元、(13725.7±1690.4)元,均差异有统计学意义(P<0.05)。日间手术组结石清除率85.4%,住院手术组为93%,两组间差异无统计学意义(P>0.05)。比较两组平均手术时间、术后血红蛋白下降值、术后无管化率、完全无管化率、VAS疼痛评分及并发症发生率,差异无统计学意义(P>0.05)。日间手术组再入院率2.1%,住院手术组2.7%,两组间差异无统计学意义(P>0.05)。结论:日间手术模式下开展超细经皮肾镜取石术安全可行,可有效缩短住院时间,降低医疗费用。严格筛选合适的患者,有效执行"加速康复外科"理念,由经验丰富的医师进行手术,麻醉和护理团队的精细化围手术期管理,是成功开展超细经皮肾镜取石术日间手术模式的有力保障。
Objective:To investigate the feasibility and safety of ultra-mini percutaneous nephrolithotomy(PCNL)in day surgery mode.Methods:The clinical data of patients with renal calculi or upper ureteral calculi treated by ultra-mini PCNL from June 2015 to March 2019 were retrospectively analyzed.There were 287 cases in day surgery group and 75 cases in inpatient group.There was no significant difference in sex,age,stone size and hydronephrosis between the two groups.The stone-free rate,operating time,hospital stay,medical cost,complications and re-admission rate were compared.Results:The mean hospital stay in day surgery group was significantly shorter than that in inpatient group[(1.2±0.8)vs.(2.6±0.9)d(P<0.05)].Similarly,the mean medical cost in day operation group was markedly lower than that in inpatient group[(12623.8±3141.4)vs.(13725.7±1690.4)yuan(P<0.05)].The stone-free rate was 85.4%in day surgery group and 93%in inpatient group.There was no significant difference between the two groups(P>0.05).There was no significant difference between the two groups in the mean operating time,the hemoglobin drop,the percentage of tubelessness or total tubelessness,visual analog scale and incidence of complications(P>0.05).The re-admission rate in day surgery group was comparable with that in inpatient group(2.1%vs.2.7%,P>0.05).Conclusions:Ultra-mini PCNL in day surgery mode is safe and feasible,which can effectively shorten hospital stay and reduce medical costs.Strict screening of suitable patients,effective implementation of enhanced recovery after surgery,operation by experienced doctors,fine perioperative management by anesthesia and nursing team are the strong guarantee for successful ultra-mini PCNL in day surgery mode.
作者
宣寒青
陈奇
杜柘彬
仲海
曹炀
夏磊
薛蔚
XUAN Hanqing;CHEN Qi;DU Zhebin;ZHONG Hai;CAO Yang;XIA Lei;XUE Wei(Department of Urology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)
出处
《微创泌尿外科杂志》
2020年第4期234-239,共6页
Journal of Minimally Invasive Urology
基金
上海申康医院发展中心临床创新三年行动计划(16CR4006A)
关键词
日间手术
经皮肾镜取石术
超细经皮肾镜取石术
肾结石
输尿管结石
day surgery
percutaneous nephrolithotomy
ultra-mini percutaneous nephrolithotomy
renal calculi
ureteral calculi
作者简介
通信作者:陈奇,chenqirji@163.com
