■报告我们在手术后24小时内早期出院的日间护理经皮肾镜取石术(PCNL)的初步经验。
■对2020年1月1日至2022年12月31日期间接受PCNL治疗的患者的档案进行回顾性审查。日间护理PCNL定义为患者在手术后同一天或24小时内出院。患者年龄,ASA得分,身体质量指数,石头直径,偏侧性,石头负担,Hounsfield单位,和盖伊的分数进行了分析。手术时间,通道的大小,碎石方法,估计失血量,并记录住院时间。根据Dindo-Clavien分类对术后并发症进行分层。主要结果是与手术后住院至少2天的住院患者相比,评估PCNL后24小时内早期出院的可行性和安全性。
■我们中心共有85例患者接受PCNL,其中36例患者在手术后24小时内出院(日间PCNL),49例患者至少住院2天(住院PCNL)。在日托小组中,中位结石负荷为465mm2(360-980),18例(50%)患者的Guy's结石评分≥III.在日间护理组中,中位管道大小为24(13-30),其中7例进行了内镜联合肾内手术(ECIRS)。在日间护理手术组中88.8%进行了无内胎PCNL,而在住院患者组中为37.5%(p<0.0001)。两组术后并发症发生率相当(日间护理组与住院组相比为13.8%vs22.4%,分别,p=0.08)。
■日间护理PCNL对于选定的患者(包括结石负担较大的患者)是可行且安全的,不会增加并发症或再入院率的风险。
UNASSIGNED: To report our initial experience of day care percutaneous nephrolithotomy (PCNL) with early hospital discharge within less than 24 hours of the procedure.
UNASSIGNED: The files of patients treated with PCNL between 1st January 2020 till 31st December 2022 were retrospectively reviewed. Day care PCNL was defined as the discharge of patients either on the same day or within 24 hours after surgery. Patient age, ASA score, body mass index, stone diameter, laterality, stone burden, Hounsfield unit, and Guy\'s score were analyzed. Operative time, size of the access tract, method of lithotripsy, estimated blood loss, and length of hospital stay were also recorded. Postoperative complications were stratified according to the Dindo-Clavien classification. The primary outcome was to evaluate the feasibility and safety of early discharge within 24 hours after PCNL compared to the in-patients who were kept in hospital for at least 2 days after surgery.
UNASSIGNED: A total of 85 patients underwent PCNL at our center of whom 36 patients were discharged within 24 hours (day care PCNL) of the procedure and 49 patients were kept for at least 2 days (in-patient PCNL). In the day care group, median stone burden was 465 mm2 (360-980) and 18 patients (50%) had Guy\'s stone score ≥ III. The median tract size was 24 (13-30) and endoscopic combined intrarenal surgery (ECIRS) was performed in 7 cases in the day care group. Tubeless PCNL was carried out in 88.8% of the day care surgery group compared to 37.5% in the in-patient group (p < 0.0001). The postoperative complication rate was comparable between both groups (13.8% vs 22.4% for day care vs in-patient group, respectively, p = 0.08).
UNASSIGNED: Day care PCNL is feasible and safe for selected patients including those having large stone burden without increasing the risk of complications or readmission rate.