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Abstract：
Background: Percutaneous nephrolithotomy is the gold standard treatment for large, complex intrarenal stones. Historically, this was performed using a nephrostomy tube (PCN) and/or internalized ureteral stent at the end of the procedure. However, totally tubeless nephrolithotomy (tt-PCNL) is a novel technique where no tubes (no stent nor nephrostomy tube) are left post-operatively. We review the literature on this subject regarding peri-operative outcomes, post-operative outcomes, and potential complications of the procedure, discuss our technique, and make recommendations on implementation for centers not currently utilizing the procedure. Materials and methods: We performed a comprehensive search of the literature on totally tubeless nephrolithotomy using MEDLINE database search. Our search included prior review articles, meta-analyses, systematic reviews, primary research articles, case reports, and case studies. Results: In comparison to prior approaches where a stent or nephrostomy tube is placed, tt-PCNL has a similar complication rate and better post-operative outcomes. Totally tubeless PCNL has similar operative times and similar changes in hemoglobin. However, it had shorter length of stays across all studies. The mean difference in length of stay in the studies reviewed was 1.96 days. Additionally, tt-PCNL had decreased post-operative analgesic requirements and pain scores. Conclusions: This review highlights totally tubeless percutaneous nephrolithotomy as a safe and feasible surgical technique with improved outcomes in properly selected patients.
摘要：
背景:经皮肾镜取石术是治疗大型肾结石的金标准,复杂的肾内结石。历史上,手术结束时使用肾造瘘管(PCN)和/或输尿管内支架进行手术.然而,完全无管肾镜取石术（tt-PCNL）是一种新颖的技术，术后无管（无支架或肾造瘘管）。我们回顾了关于围手术期结果的文献，术后结果，以及手术的潜在并发症，讨论我们的技术，并就目前未使用该程序的中心的实施提出建议。材料和方法：我们使用MEDLINE数据库搜索对完全无管肾镜取石术的文献进行了全面搜索。我们的搜索包括以前的评论文章，荟萃分析，系统评价,主要研究文章，病例报告,和案例研究。结果：与先前放置支架或肾造瘘管的方法相比，tt-PCNL具有相似的并发症发生率和更好的术后结果。完全无管PCNL具有相似的手术时间和相似的血红蛋白变化。然而,在所有研究中，它的停留时间较短。在所审查的研究中，住院时间的平均差异为1.96天。此外,tt-PCNL降低了术后镇痛需求和疼痛评分。结论：这篇综述强调了完全无管化经皮肾镜取石术是一种安全可行的手术技术，可在适当选择的患者中改善预后。
