多孔道經皮腎造瘻碎石取石手術在複雜性結石的經驗

陳致豪、蘇家震、劉建良、黃冠華

奇美醫院 外科部 泌尿科

One-stage percutaneous nephrolithotomy with multi-tract using both standard and mini tract to deal with complicated stone: case experience

Zhi-Hao Chen, Chia-Cheng Su, Chien-Liang Liu, Steven Kuan-Hua Huang M.D. Ph.D

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

Introduction: Management of patients with complete staghorn stone remains a huge issue during cilnical practice. Fisrt-line therapy is still percutaneous nephrolithotomy(PCNL). Multiple times of PCNL is also one way for stone manipulation, but the patients have to go through many times of surgery. Management of complete staghorn stone with only one PCN tract can be diffucult and sometimes impossible to be totally stone-free. Therefore, we practiced a way to perform one-stage PCNL with multi-tract using both standard and mini PCN tract, and hoped to benefit more patients.

Surgical Methods: During operation, we performed PCN first by PCN tract creation using hybrid room device. A standard 28 Fr Ampulla sheath tract and a mini-PCN tract were created. Nephroscopy was inserted and identify the stone location. Gentally fragmented the occupied stone with lithoclast and ultrasonic devices, remove the stone with stone forcep. Remove the stone and free the stone fragments as possible. There are 3 cases using this method and had good stone free condition.

Conclusions: One-stage PCNL with multi-tract using both standard and mini tract is an efficient and safe way to manupilate kidney staghorn stone. It offered an alternative option for urologists to deal with complicated stone during clinical practice.