经皮肾造瘘术与输尿管支架在梗阻性尿石症中患者报告结局的比较：STONE随机对照试验结果

Objective: To compare the effects of percutaneous nephrostomy (PCN) and JJ ureteric stent (JJ) for urinary tract decompression in patients with obstructive urolithiasis on health-related quality of life (HRQoL), pain scores, urinary symptoms, and patient satisfaction. Patients and methods: In 11 hospitals, 204 patients with obstructive urolithiasis were randomised to JJ or PCN placement. Patient-reported outcome measures (PROMs) were assessed until stone passage, surgical removal, or at 3 months. Results: Both PCN and JJ effectively improved HRQoL index scores (PCN: pre-decompression 0.70, 1 day post-decompression 0.82, P = 0.003; JJ: pre 0.59, post 0.85, P < 0.001), pain scores (PCN: pre 4.9, post 1.3, P < 0.001; JJ: pre 5.5, post 1.3, P < 0.001), and achieved patient satisfaction (score at discharge PCN: 7.9; JJ: 8.2), with no significant differences between interventions in overall HRQoL (generalised estimating equation [GEE] P = 0.7) or mean daily pain scores (GEE P = 0.4). PCN led to more self-care difficulties (patients reporting no problems: PCN 74%, JJ 91%, P = 0.023), while JJ recipients reported more urinary symptoms and higher peak pain intensity (pain score PCN: 2.3, JJ: 3.7, between groups P = 0.018). Despite symptoms, more JJ recipients preferred the same intervention in future (60%), than PCN recipients (31%) (P < 0.001). Survey-based data collection may introduce response bias (response rate 59%). Conclusion: In patients with obstructive urolithiasis, urinary decompression with PCN and JJ improved HRQoL and pain comparably. JJ causes more urinary symptoms and peak pain but allows better self-care. Baseline self-care and urinary symptoms should guide shared decision-making. Drainage duration should be minimised.