經皮腎取石術使用氣球擴張方式初步經驗分享
陳柏華、王百孚、林介山、江恆杰、張進寶、嚴孟意
黃國軒、黃勝賢、陳俊吉、石宏仁、張建祥、陳建廷
彰化基督教醫院 外科部 泌尿科
Initial experience using balloon dilator during percutaneous nephrolithotomy
Pao-Hwa Chen, Pai-Fu Wang, Jesen Lin, Heng-Chieh Chiang, Chang-Pao Chang, Meng-Yi Yan, Kuo-Hsuan Huang, Sheng-Hsien Huang, Chun-Chi Chen, Hung-Jen Shih, Jian-Xiang Zhang, Jian-ting Chen
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Purpose: The endoscopic management of urolithiasis have been proven to provide stone clearance for almost all of patients. The choice of management depend on location and size of the calculi. For large symptomatic renal calculi, percutaneous nephrolithotomy (PCNL) provide the highest stone clearance rate. The method of establishing percutaneous nephrostomy tract have evolved through the years. Balloon dilators provide a fast one-step method in establishing tract. Here, we present our initial 1 year experience with balloon dilator.
Material and Methods: Our hospital started using balloon dilator for nephrostomy tract during PCNL since August 2014. From August 2014 to July 2015, we performed 154 PCNL procedures at our hospital under C-arm guidance. We retrospectively review the medical records and record the peri-operative and post-operative data and complications. We analyze the data and review the related complications. Clavien-dindo classification was used to analyze the post-operative complication.
Results: One hundred fifty-four patients underwent PCNL procedure from August 2014 to July 2015. The men to women ratio is 2:1. The average stone burden from KUB is 771 mm2. The main puncture are senior residents (R4 to Fellow). The stone free rate of 78%. Patients with residual stone are the ones with higher stone burden on KUB (average: 1500 mm2), which is twice the average of the whole patient population. Total patient experienced post-operative complication is 48% (n=64). Most of the complication is Clavien grade 1-2. There were 7 patients with Clavien grade 3-4 and no mortality.
Conclusion: The initial experience with balloon dilator has been very positive. The complication rate has been similar to other reported from CROES studies. Future randomized trials are needed to establish the benefit of balloon dilator.