針對巨大鹿角石的處理： 經皮腎臟造廔碎石術與開刀截石手術之比較性研究
張博淵1林文榮1許炯明1張奐光1林文州1陳建志1
馬偕紀念醫院 泌尿科1
Comparative study of percutaneous nephrolithotomy versus open stone surgery for management of patients with large staghorn calculi
Friedrich Bo-Yuan Zhang1, Wun-Rong Lin1, Jong-Ming Hsu1, Huang-Kuang Chang1,
Wen-Chou Lin1, Marcelo Chen1
1Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
Purpose:
Advances in shock wave lithotripsy and endourological procedures have further limited the need for open surgery in the treatment of renal stones. We reviewed our experience of percutaneous nephrolithotomy (PNL)-based therapy with open stone surgery (OSS) to determine the clinical outcomes of these therapeutic modalities.
Materials and methods:
This retrospective study was conducted at Mackay Memorial Hospitals (Taipei and Tamsui), Taiwan. Hospital and office charts, operative records, and pertinent radiographic studies of all patients undergoing OSS (11 patients) and PNL (61 patients) for the treatment of large staghorn calculi from December 2007 through June 2013 were reviewed. Only patients with stones 10 cm2 or greater were included. Patient characteristics, stone burden, indications, surgical outcomes, and differences between the two procedures were compared and analyzed. Stone-clearance status was confirmed with postoperative kidney, ureter, bladder X-rays.
Results:
There were no differences between the two groups in patient demographics, stone size, estimated blood loss and mean renal function level change. However, there were statistically significant differences between the groups in mean operative time (282.1 ± 54.5 [range: 187-340] vs. 156.6 ± 41.2 [range: 85-285] minutes), mean hospital stay (10.27 ± 1.79 [range: 8-14] vs. 6.18 ± 2.71 [range: 2-17] days), postoperative stone-clearance rate (97.5 vs. 76.1%) and number of procedures per patient (1.55 vs. 2.77).
Conclusions:
In our experience, OSS should still be considered a valid and efficient treatment option for patients with complete staghorn calculi, although PNL is the standard treatment for most cases of renal stones.