在仰臥方式以硬式與軟式腎臟鏡處理經皮腎臟造瘺孔碎石之經驗
凌永耀1,3、吳振宇1、林嘉祥1,2
1.義大醫療財團法人義大醫院泌尿科，2.義守大學醫學院醫學系，3.建佑醫院泌尿科
Combined Flexible and Rigid Nephroscope for supine percutaneous nephrolithotomy- Preliminary report
Yung-Yao Lin1,3, Richard C. Wu1、Victor C. Lin 1,2
1. Department of Urology, E-Da Hospital, Kaohsiung, Taiwan 2. Department of Urology, E-Da Hospital, Kaohsiung, Taiwan 3. Chien-Yu Hospital, Division of Urology, Kaohsiung, Taiwan
Purpose:
Along the single percutaneous nephrolithotomy tract, we use flexible nephroscope to find the residual stone which cannot be found via the rigid nephroscope and disintegrated it by Holium laser.
Materials and Methods:
Patients diagnosed with kidney stones who were scheduled to undergo percutaneous nephrolithotomy (PCNL). Post radiologist placing a percutaneous nephrostomy tube and guide-wire, the PCN tract was created with a straight type urethrotomy knife inserted through 21 Fr Storz urethrotome (Karl Storz, Germany) in a modified supine position. We use flexible nephroscopy to find the residual renal stone post rigid nephroscopy during PCNL in supine position. Laser lithotripsy and basket catheter stone extraction were done.
Results:
There were 6 patients accepted combined flexible and rigid nephroscopy supine PCNL during 2019 Jun to 2020 March at Eda Hospital and Chien-Yu Hospital. Only one patient had residual renal stone and 2 patients had low grade fever post operation. No obvious decreased level of Hb or elevated renal function were found post operation. There were no blood transfusion post operation and all patients were discharged in 4 or 5 days post operation.
Conclusion:
Combined flexible and rigid nephroscopy supine PCNL is a safe and feasible approach in treatment of complex stone disease. It has the advantages of both approaches and may reduce the need of multiple operations.