超音波導引斜仰臥截石位經皮穿腎迷你腎臟鏡碎石術:單中心經驗

柳易揚、沈元琦、羅浩倫、王弘仁、陳建旭、陳彥達、莊燿吉、劉惠瑛、張殷綸、陳柏諺

高雄長庚紀念醫院 泌尿科

Ultrasound Guided Mini Percutaneous Nephrolithotomy in Galdakao-Modified Supine Valdivia Position: Single Center Experience

Yi Yang Liu, Yuan Chi Shen, Hao Lun Luo, Hung Jen Wang, Chien Hsu Chen,

Yen Ta Chen, Yao Chi Chuang, Hui Ying Liu, Yin Lun Chang, Po Yen Chen

Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Purpose:

To conduct a retrospective, single center case study for ultrasound guided mini percutaneous nephrolithotomy (PCNL) in Galdakao-modified supine Valvidia (GMSV) position with respects to stone free rate, hemoglobin drop, renal function change, and complications.

Materials and Methods:

We retrospectively reviewed 55 patients of renal or upper ureteral stones who underwent single tract ultrasound guided mini PCNL in GMSV position from December 2019 to March 2021. All the perioperative parameters were collected for analysis. The efficacy was evaluated by the plain KUB on the day after operation. The residual stone fragment less than 4 mm was defined as stone free status. Besides, hemoglobin drop, renal function change and complications were also analysed.

Results:

In these 55 patients, mean age was 56.75 years-old. Mean stone size was 29.6mm (380 mm²). In stone complexity, the mean S.T.O.N.E. scores was 7.16, including 7 patients (12.7%) with the scores ≧9. The operation takes about 60.9 minutes. In the postoperative outcomes, 51 (92.7%) patients were stone free. Moreover, mean Hb drop was 1.32 g/dL. Mean difference of estimated glomerular filtration rate (eGFR) was 12.28 mL/min/1.73m², and 53 patients (96.4%) showed stable or improved renal function postoperatively. Complications include fever (N=10, 18.1%) and sepsis (N=2, 3.6%), which were subsided spontaneously or after medical treatment in a few days. There were no grade III or more severe complications by Clavien-Dindo classification.

Conclusion:

In this study, we proved that ultrasound guided mini PCNL in GMSV position is a feasible and effective operation for patient with renal and ureteral stones with safety.