無腎管經皮腎造瘻取石術處理巨大結石安全性及結果之探討
蕭夙娟、林昌德、沈正煌、鄭明進、周詠欽、陳丕哲、賴韋宏
嘉義基督教醫院 外科部 泌尿科
Safety and efficacy of tubeless percutaneous nephrolithotomy in patients with large stone
Shu-Chuan Hsiao, Chang-Te Lin, Cheng-Huang Shen, Ming-Chin Cheng,Yeong-Chin Jou , Pi-Che Chen, Wei-hong Lai
Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose: To evaluated the safety and efficacy of tubeless PCNL in patient with large stone.
Materials and Methods: Since January 2011 to June 2016, 425 tubeless PCNL was performed at our hospital. All patients received one stage procedure with metal dilator. After the complete of stone extraction, the access tract was cauterized and the access tract of the renal parenchyma was packed with Surgicele. A bloodless tract usually could be obtained and all of patients underwent tubeless modification. Of the 425 patients, 93 patients have their stone size ≧5 cm (mean:7.77cm, Group 1) and 332 patients have their stone <5 cm (mean:2.75cm, group 2). The results of these patients were analyzed with retrospective chart review and software SPSS V.21.
Results: The operation time is high in group 1 (93.6 versus 70.4 minutes, p=0.000) There was no significant difference in the incidence of postoperative fever (8% versus 7%) and sepsis (1% versus 1%) between both groups. There is also no statistical difference in the postoperative hospital stay (3.05 days versus 3.20 days). In group 1 the transfusion rate is higher (6/93 versus 4/332, p=0.003); however there is no other major complication or conversion into open surgery in both group.
Conclusions: Tubeless PCNL in patients having their ≧5 cm has a reasonable and acceptable higher transfusion without other major complication.