無管單孔迷你經皮腎臟碎石術對鹿角結石之療效

周主民、陳丕哲、周詠欽、鄭明進、沈正煌、林昌德

嘉義基督教醫院 外科部 泌尿科

Tubeless, Single Puncture, Mini-Percutaneous Nephrolithotomy for Staghorn stones

Chu-Min Chou, Pi-Che Chen, Yeong-Chin Jou, Ming-Chin Cheng, Cheng-Huang Shen, Chang-Te Lin

Divisions of Urology, Department of Surgery, Chiayi Christian Hospital

Purpose:

To evaluate outcome of staghorn stones treated with tubeless, single puncture miniaturized percutaneous nephrolithotomy (mini-PCNL) at a single medical unit.

Materials and Methods:

Between January 2017 and December 2020, a total of 43 patients underwent tubeless mini-PCNL for renal staghorn stones were enrolled in this study. Patient and stone characteristics, perioperative outcomes, and complications were reviewed. Stone burden reduce rate was defined as reduce percentage of longest axial diameter measured on pre-operative and post-operative KUB.

Results:

Of the 43 patients there were 24 males and 19 females. The average longest axial diameter was 6.02 cm in size, and average stone burden reduce rate was 81.8%. Post-operative laboratory data was collected in 29 patients, and average decreased of hemoglobulin by 0.7 g/dL was noted. Post-operative transfusion rate was 7% (3 patients with packed RBC). 3 (7%) patients had post-operative febrile events, and one (2.3%) patient was transferred to intense care unit due to sepsis. Total adjuvant treatment rate was 58%, with 22 (51.2%) patients underwent extracorporeal shock wave lithotripsy (ESWL), 2 (4.6%) received retrograde intrarenal surgery (flexible ureteroscopic lithotripsy) and 1 (2.3%) had second time mini-PCNL.

Conclusions:

Tubeless, single puncture, mini-PCNL is safe and feasible treatment for renal staghorn stones. Although stone free rate may be limited due to number of punctures, the stone burden is prominently reduced. Most of the residual stones can be treated successfully with medical expulsive treatment or extracorporeal shock wave lithotripsy.