無腎造瘻管肋間經皮腎造瘻取石術並不增加併發症: 前瞻性比較肋間與肋下穿刺所產生的併發症
Supra-costal tubeless percutaneous nephrolithotomy is not associated with increased complication rate: A prospective study of safety and efficacy of supra-costal versus sub-costal access.
Pao-Hwa Chen, Meng-Yi Yan, Jesen Lin, Heng-Chieh Chiang, Bai-Fu Wang Chen
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
陳柏華、嚴孟意、林介山、江恆杰、王百孚
彰化基督教醫院 外科部 泌尿科
Purpose
A higher complication of supracostal approach is noted in standard PCNL (percutaneous nephrolithotomy). This prospective study was designed to compare morbidities of tubeless PCNL using supra-costal or subcostal access.
Materials and methods
From January 2009 to December 2014, a single surgeon performed 128 consecutive patients underwent one-stage fluoroscopic-guide percutaneous nephrolithotomy for complex renal and upper ureteral stone. Surgical indications include: staghorn stones, renal calculi >2 cm in diameter, upper ureteral stone >1.5 cm in diameter. Exclusion criteria for tubeless PCNL included: significant bleeding or perforation of the collecting system, large residue stone, multiple PCNL tract and obstructive renal anatomy. Morbidity, operation time, analgesia requirement, length of hospital stay, stone- free rate, were analyzed.
Results
Total of 86 tubeless PCNL (56 supra-costal and 30 subcostal) were performed in our study period. The mean age, operation side, stone locations were similar. The male to female ratio is higher in supra-costal than subcostal (13/17). Large renal stones and staghorn stones makes up for most patients (supra-costal: 75%, subcostal: 80%). The stone–free rate of supra-costal group was 59% (33/56) and in subcostal group was 50 % (15/30). The operative times, length of stay, post-op analgesic use, hematocrit change was similar in both groups. The overall complication rate is 6% (supra-costal (1/56), subcostal (4/30)) with the majority being infectious complications.
Conclusions
Supra-costal access above 12th rib during tubeless PCNL is safe and effective procedure and is not associated with higher incidence of post-op complications in experience hands.