改良式的Floseal使用技巧於經皮腎造廔取石術病患–台中榮總的初期經驗
陳正哲1、陳韋辰1、陳文銘1, 2
1臺中榮民總醫院 外科部 泌尿外科; 2衛生福利部彰化醫院泌尿科
New method of Floseal® application on PCNL patients, initial experience in TCVGH
Cheng-Che Chen1、Wei-Chen Chen1、Wen-Ming Chen1, 2
1Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital; 2Chang-Hua Hospital, Ministry of Health and Welfare
Introduction: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical technique that significantly reduce the morbidity of stone removal. However, severe bleeding after PCNL may happen in rare cases, which may cause prolonged hospital stay and additional medical expenses. FloSeal® was used to help hemostasis in many procedures. We provide a modified skill for safer approach.
Materials and Methods: Between September 2011 and December 2016, there were 25 patients with renal stones, who underwent PCNL by a single surgeon in this institute using FloSeal® (Baxter Healthcare Corporation, Fremont, CA, USA). After conventional PCNL, a nephrostomy tube was placed in renal pelvis. And then, an 8-French Foley’s catheter was inserted into the retroperitoneal cavity with the balloon dilated by 3ml of distilled water. FloSeal® was injected through the Foley catheter to seal up the cavity, and help hemostasis for renal parenchyma. We analyze the blood loss by hemoglobin changes, transfusion rate, and hospital stay.
Results: There were 25 patients with renal stones who received PCNL using FloSeal® to help hemostasis in this study. The average age is 61.6. The mean stone clearance rate is 79%. The mean preoperative Hb is 12.0, and the average Hb change is 1.3. Transfusion was performed in 8 patients (32%). Mean duration of nephrostomy tube placed was 1.7 days. Mean hospital stay was 5.5 days.
Conclusions: PCNL using FloSeal® to help hemostasis is a safe and feasible procedure. The skill that we provide can decrease the medical expenses during the postoperative care and shorter hospital stay.