經皮腎造口結石術後腸阻塞機率可能超於我們預期-單一醫學中心的經驗
鄭百諭、吳維哲、鍾旭東
亞東紀念醫院 外科部 泌尿科
Post percutaneous nephrolithotomy ileus may be more common than we thought – A single medical center experience
Pai-Yu Cheng, Wei-Che Wu, Shiu-Dong Chung
Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
Purpose: Several complications of percutaneous nephrolithotomy (PNL) were published in previous literature, such as hemorrhage, fever, sepsis, urine leak and ileus. Among those complications, transient paralytic ileus was thought to be minor event with low incidence rate(2.6%). However, the incident rate was high in our clinical practice, and associated risk factors as well as impact to patient outcome were not identified.
Materials & Methods: From March 2014 to August 2017, we retrospectively analyzed 89 cases who received standard PNL and 40 cases who underwent tubeless PNL respectively. Patient’s demographics, stone size, presence of staghorn stone, operation time, and stone-free status were reviewed. Postoperative ileus was defined as small bowel diameter greater than 3cm or large bowel diameter greater than 6cm from KUB within 24 hours post-PNL. The patients with preoperative ileus noted from KUB were excluded. SPSS Ver. 19 was used for statistic analysis. P value less than 0.05 is considered to be statistically significant.
Results: The overall incidence of postoperative ileus was 37.2%. The patient characteristics between these two groups were consistent, regarding age, gender, and selection for standard or tubeless PNL (Table 1). There was no statistical significance in stone size, presence of staghorn stone, stone free rate and hospitalization length. The postoperative prokinetic/laxative agent use was more in postoperative ileus group, but no statistical significance was found. Left side PNL procedure was predominant in our study, and 81% patient in postoperative ileus group was found to receive left side PNL(P=0.002). In univariate logistic regression, left side PNL was found to be the risk factor for postoperative ileus(OR=3.644, 95% CI=1.563-8.495, P=0.003) (Table 2).
Conclusion: The post-PNL ileus incidence was higher in our study, although the need for prokinetic/laxative agent use and postoperative hospitalization length were not statistically significant. Left side PNL was identified as the risk factor for development of postoperative ileus, but the clear mechanism needs to be further investigated.