無腎管經皮腎造瘻取石術術後放置後腹腔引流管安全性及併發症之探討
蕭夙娟、陳丕哲、鄭明進、周詠欽、沈正煌、林昌德、賴韋宏
嘉義基督教醫院 外科部 泌尿科
Is Retropertoneal drain necessary
for tubeless percutaneous nephrolithotomy?
Shu-Chuan Hsiao, Pi-Che Chen, Ming-Chin Cheng , Yeong-Chin Jou , Cheng-Huang Shen, Chang-Te Lin , Wei-hong Lai
Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose: To evaluate the relationship of retroperitoneal drain insertion and postoperative complications in patients undergoing tubeless percutaneous nephrolithotomy(PCNL).
Materials and Methods: From December 2000 to June 2017, 1253 tubeless PCNL was performed at our hospital. All patients received one stage and single tract creation procedure with metal dilator. Prophylatic antibiotic with cefazoline or according to preoperative urine culture was given to every patient. The clinical results and their relationship between retroperitoneal drain insertion or not in these patients were analyzed with retrospective chart review and software SPSS V.21.
Results: Among the 1253 patients, 827 patients were male and 426 patients were female. There were 489 patients in group 1 without post-operative retroperitoneal drain and 764 patients in group 2 with post-operative Penrose drain. The age of group 1 ranged from 16 to 86 (mean 54.59±11.74). The age of group 2 ranged from 20 to 86 (mean 54.38±12.54). There was no statistically significant difference in post-operative overall complications between two groups. However, the retroperitoneal drain insertion will increase thorax complications(1.6%, p=0.005) such as pleural effusion(5.6% vs 0%),hemo-pneumothorax(0.7% vs 0%), pneumomediastinum (0.1% vs 0%,). Retroperitoneal drain insertion will also increase the risk of post-operative fever(4.2% vs 0.8%, p=0.000). The sepsis or septic shock rate was not statistically significant difference between the two groups (1.4% vs 1.2 %, p=0.697). The blood transfusion rate was not statistically significant difference between the two group(2.7% vs 3 %).To apply Penrose drain insertion or not will not relate to post-operative overall complications but pleural complications. All these patients with complications recovered well after optimal medical and surgical treatment
Conclusions:. Retroperitoneal drain insertion will increase risk of post-operative pulmonary complications after tubeless PCNL. It also will increase fever rate. Retroperitoneal drain placement is not recommended after the PCNL