針對腎臟鹿角型結石比較雙鏡聯合腎內取石手術與多孔道經皮腎鏡取石術:單一醫學中心的手術經驗

陳致豪、李高漢、曾文歆、蘇家震、謝昆霖、林才揚、黃冠華

奇美醫學中心外科部泌尿科

Comparison of Mini Endoscopic Combined Intrarenal Surgery and Multitract Percutaneous Nephrolithotomy Specifically for Kidney Staghorn Stones: A Single-Center Experience

Zhi-Hao Chen¹, Kau-Han Lee ¹, Wen-Hsin Tseng¹, Chia-Cheng Su¹, Kun-Lin Hsieh¹, Chye-Yang Lim¹, Steven K. Huang¹

Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Abstract

Purpose: Staghorn stones require surgical treatment to prevent serious complications such as kidney failure, infection, and septic shock. Percutaneous nephrolithotomy for staghorn stones requires creation of multiple tracts for different calyces, a technique called multitract percutaneous nephrolithotomy (multitract PCNL). However, creation of multiple tracts causes greater renal parenchymal injury and blood loss. Endoscopic combined intrarenal surgery (ECIRS) was developed to overcome these limitations of multitract PCNL. One-stage ECIRS entails combined use of antegrade nephroscope and retrograde flexible ureteroscope to clear the staghorn stone. We aimed to compare the perioperative outcomes of mini ECIRS and multitract PCNL in the management of staghorn stones.

Method: This was a retrospective single-center study of patients with staghorn stones who underwent ECIRS (n = 17) or multitract PCNL (n = 17) between January 2018 and September 2021.

Result: There was a significant between-group difference with respect to Guy’s stone score. Stone size, stone burden[ECIRS group: 21.41 cm3; multitract PCNL group: 20.88 cm3 (P = 0.94)], and degree of hydronephrosis were comparable in the two groups. Mean operative time was not significantly different between the groups [ECIRS group: 140 min; multitract PCNL group: 183 min (P = 0.63)]. There was no significant between-group difference with respect to one-step stone-free rate or final stone-free rate. ECIRS was associated with significantly lesser postoperative pain. Hemoglobin loss, postoperative blood transfusion rate, complications, and length of hospital stay were comparable in the two groups.

Conclusions: Both mini ECIRS and multitract PCNL were effective and safe for the management of renal staghorn stones with comparable operation time and stone-free rate, and complications. ECIRS was associated with less severe postoperative pain.