关键词: 非逆行插管, 部分无管化, 经皮肾镜取石术, 肾盂分离度

Abstract:

Objective To evaluate the safety and efficacy of non-retrograde intubation combined with selectively tubeless percutaneous nephrolithotomy （NR-ST-PCNL）. Methods A retrospective analysis included 213 patients with upper urinary tract stones and hydronephrosis （renal pelvic separation > 10 mm） undergoing PCNL at our hospital from October 2023 to June 2025. Patients were divided into Group A （non-retrograde intubation， n = 109） and Group B （retrograde intubation， n = 104）. Primary endpoint was postoperative complications and secondary endpoints included operative time， stone-free rate （SFR）， visual analog scale （VAS） pain scores， postoperative hospital stay， and hospitalization costs. Results Group A demonstrated significantly lower rates of postoperative complications ［7.3% （8/109） vs. 18.2% （19/104）， P = 0.017］， shorter operative time ［51.00 （37.00， 65.00） min vs. 71.50 （55.00， 90.75） min， P < 0.001］， lower postoperative VAS scores ［1.00 （0.00， 1.00） vs. 1.00 （0.00， 2.00）， P = 0.008］， shorter hospital stay ［3.00 （2.00， 3.00） days vs. 4.00 （4.00， 4.00） days， P < 0.001］， and lower hospitalization costs ［17 028.00 （15 178.05， 17 934.50） RMB vs. 20 653.00 （19 176.25， 22 630.00） RMB， P < 0.001］ compared with Group B. There was no significant difference in SFR between groups （P > 0.05）. Conclusion For patients with upper urinary tract stones and renal pelvic separation > 10 mm， NR-ST-PCNL performed by experienced surgeons achieves comparable stone clearance to conventional techniques while reducing complication risk， shortening operative and hospitalization times， and lowering costs. It represents a safe， efficient， and optimized clinical approach.

Key words: non-retrograde, partiallytubeless, percutaneous nephrolithotomy, renal pelvic separation