於複合式手術室中應用錐形束電腦斷層輔助之經皮腎造廔取石術，或併逆行性軟式輸尿管鏡手術：單一醫學中心之初步經驗

李明儒^1,2、許珀瑜³、耿俊閎^1,2

¹高雄市立小港醫院 泌尿科；²高雄醫學大學附設中和紀念醫院 泌尿科，³一般科

Cone-Beam CT-Assisted Percutaneous Nephrolithotomy with or without Concomitant Retrograde Intrarenal Surgery in a Hybrid Operating Room: An Early Single-Center Experience

Ming-Ru Lee^1,2, Po-Yu Hsu³, Jiun-Hung Geng^1,2

¹ Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan;

² Department of Urology and ³ Department of General Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Purpose: Hybrid operating rooms allow percutaneous nephrolithotomy (PCNL) and adjunctive endoscopy to be combined with intraoperative cone-beam or immediate computed tomography (CT). However, real-world outcome data remain limited.

Materials and Methods: We retrospectively analyzed 79 consecutive stone procedures recorded in a hybrid operating room database. To align with a PCNL-based study aim, the primary analytic cohort was defined as cases with at least one percutaneous tract (Tract ≥1; n=63). Immediate CT use was the primary exposure. The primary outcome was residual stone, defined as residual stone area >0 on the recorded postoperative/immediate imaging field. Secondary outcomes included transfusion, postoperative fever, complication grade ≥2, operative time, and length of stay.

Results: In the PCNL-based cohort, median age was 58 years (IQR 46-67.5) and 37/63 (58.7%) were male. Staghorn stones were present in 40/63 (63.5%) cases, and immediate CT was used in 28/62 (45.2%). Residual stones occurred in 9/62 (14.5%), transfusion in 17/62 (27.4%), postoperative fever in 8/61 (13.1%), and grade ≥2 complications in 22/61 (36.1%). Immediate CT use was not associated with lower residual stone rate (4/28 [14.3%] vs 5/34 [14.7%], p=1.000) or lower transfusion rate (8/28 [28.6%] vs 9/33 [27.3%], p=1.000). On univariable analysis, larger stone area (OR 1.25, 95% CI 1.00-1.56, p=0.047) and multiple tracts (OR 7.03, 95% CI 1.55-31.98, p=0.012) were associated with residual stone. In multivariable analysis, multiple tracts independently predicted transfusion (adjusted OR 7.39, 95% CI 1.25-43.89, p=0.028). Operative time decreased over case order (Spearman ρ=-0.348, p=0.006).

Conclusions: In this early retrospective experience, hybrid OR PCNL-based stone surgery was feasible with an acceptable residual stone rate. Immediate CT use did not show a measurable reduction in residual stone or perioperative morbidity in this small cohort, whereas procedural complexity—especially the need for multiple tracts—was more strongly associated with adverse outcomes. Larger confirmatory studies are warranted.