雙極電燒汽化製造腎造廔口於經皮穿腎碎石手術的經驗分享

張殷綸、江博暉

高雄長庚醫院泌尿科

Experience of percutaneous nephrolithotomy with the creation of nephrostomy tract by plasma vaporization

Yin-Lun Chang, Po-Hui Chiang

Divisions of Urology, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Purpose: To share our seven-year experiences of a safe and effective method for tract creation in percutaneous nephrolithotomy (PCNL).

Materials and Methods: Total 143 patients had received this kind of method for renal stone disease by a single surgeon (CPH) at our institute from May 2010 and December 2016. Finally, total 130 patients with complete data were included. All patients undergo a bipolar resectoscope mounted with a plasma vaporization button electrode for tract creation. Data analysis included procedure time, length of hospital stay, blood transfusion rate, other early and late complications, and stone-free rate.

Results: The mean age of patients is 56.5 years (range 26–84 yrs). Noticeably, no blood transfusion is necessary in this series. Mean length of postoperative stay duration is 2.6±1.1 days. The average operating time was 46 mins. Stone-free rate was 91.6 %. All postoperative complications were Clavien grade 1 including of fever (16.9%), urine leak (1.5%) etc. Besides, no Clavien > grade 1 including of postoperative embolization, sepsis, thoracic complication etc. was noted.

Conclusions: Based on zero blood transfusion rate, no major complication, higher stone free rate (91.2%) and shorter postoperative stay duration (2.6 days). The plasma vaporization technique is safe and effective for less blood loss in comparison with other techniques, and is a simple solution for creating the nephrostomy tract for PCNL.