評估伏血凝止血劑在無腎造廔管之經皮穿腎碎石手術上治療鹿角結石的應用：回顧性比較研究

楊聿寬¹、許毓昭²、林國仁¹、謝明里¹、陳煜¹、黃世聰¹、黃信介¹、張博誌¹、蘇世桓¹、簡佑軒¹

¹林口長庚紀念醫院 外科部泌尿科；²宏仁醫院泌尿科

Evaluating the Safety and Efficacy of FloSeal^®Hemostatic Matrix in Tubeless Percutaneous Nephrolithotomy for Patients with Staghorn Stones: A Retrospective Comparative Study
Yu-Kuan Yang¹, Yu-Chao Hsu², Kuo-Jen Lin¹, Ming-Li Hsieh¹, Yu Chen¹, Shih-Tsung Huang¹, Hsin-Chien Huang¹, Po-Chih Chang¹, Shih-Huan Su¹, Yu-Hsuan Chien¹

¹Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital; ²Division of Urology, Hong Ren Hospital

Purpose: Recent studies have examined the impact of tubeless percutaneous nephrolithotomy (PCNL) on reducing hospital stays and postoperative pain. Prior research suggests that using a gelatin matrix hemostatic sealant (FloSeal^®) to close tubeless nephrostomy tracts may decrease postoperative morbidity. Our objective was to evaluate the safety and efficacy of FloSeal^® in tubeless PCNL for patients with staghorn stones.

Materials and Methods: From January 2017 to December 2022, our institution conducted PCNL on 665 patients. Within this group, 243 patients presented with staghorn stones. Of these, 104 underwent closure of the nephrostomy tract with FloSeal^®. We employed a retrograde occlusion balloon catheter and then injected FloSeal^®. We retrospectively analyzed demographic, intraoperative, and postoperative data.

Results: The group treated with FloSeal^® had a shorter postoperative stay (3 vs. 4 days; p < 0.001), a reduced rate of postoperative blood transfusion (10% vs. 27%; p = 0.001), and fewer postoperative complications (26% vs. 54%; p < 0.001). However, these patients experienced longer operative times (195 vs. 178 minutes; p = 0.002).

Conclusions: The use of FloSeal^® in the nephrostomy tract during PCNL can effectively prevent bleeding, reduce the need for postoperative blood transfusions, decrease postoperative complications, and shorten hospital stays, especially in patients with staghorn stones. Future prospective, randomized studies are necessary to define its precise clinical benefits.