經皮腎造瘻碎石取石手術處理鹿角結石，單孔道或是多孔道?:單一醫學中心經驗
蔡易辰、陳致豪、李高漢、劉建良、黃冠華
奇美醫療財團法人奇美醫學中心 外科部 泌尿科
Percutaneous nephrolithotomy for Staghorn Renal Stone
Single vs. Multiple mini tracts-single institute experiences
I-Chen Tsai, Zhi-Hao Chen, Kau-Han Lee, Chien-Liang Liu, Steven K. Huang
Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;
Purpose: Percutaneous nephrolithotomy (PCNL) is the standard management for huge renal stones. With the increasing occurrence rate and size of staghorn stones, multiple tracts of PCNL are applied to achieve better stone clearance. However, creation of multiple percutaneous tracts may have the potential risk of bleeding and higher complication rates compared with procedures using single tract. We, therefore, reviewed our experience of managing staghorn calculi with multiple tracts of PCNL compared to those with single tract or standard procedure.
Materials and Methods: The records of 47 patients with staghorn calculi who underwent PCNL were reviewed retrospectively in our institute from 2018/01 to 2019/10. A total of 14 patients were underwent multiple-tracts (group 2) access of PCNL while 12 and 21patients were managed by single-tract(group 1) access and standard procedure (group 3)separately. All groups were compared in terms of perioperative findings and postoperative outcomes, including stone size, Hb and creatinine drop values, residual stone free rates, operation time, hospital stay and complications.
Results:. A total of 47 patient (23 men and 24 women, mean age 57.1 years, range 27 to 77 years) The mean number of percutaneous accesses was 2.8 in multiple-tract group. The maximal number of tracts used was five (range two to five), most required two tracts. Mean durations of fluoroscopy screening time and operative time were longer in group 2. Stone free rate (residual stones <4mm) was 66% in group 1 and 64% in group 2 (p>0.05). The mean hospital stay period were similar in all groups(p=0.327). The complications included blood transfusion, whereas the Hb dropped (2.04±0.68 g/dL), (1.55±0.73 g/dL) and (2.05±1.3 g/dL) in single-tract, multiple-tract and standard separately. Hb dropped even lesser in group 2. The mean preoperative and postoperative creatinine concentrations were 1.34mg/dL and 1.19mg/dL in group 1, 1.3mg/dL and 1.2mg/dL in group 2, and 1.12 mg/dL and 1.09 mg/dL in group 3, respectively. The mean changes in creatinine values were not statistically significant between the groups. Other complications included urosepsis, which happened in 5 patients, (1 in group 1, 1 in group 2, 3 in group 3) and pseudoaneurysm in 1 patient (in group 1).
Conclusions:. Multiple-tract access of PCNL is an efficient and safe way to manipulate kidney staghorn stones. In managing staghorn calculi with multiple calyces involvement, PCNL with multiple accesses is a successful alternative with considerable complication rates.