比較傳統與無放置經皮腎造廔管路之經皮腎臟鏡碎石手術:單一術者初期經驗
葉志胤1、林宜佳1,2、蔡德甫1,2、莊光達、葉忠信、鄭以弘、仇光宇、陳宏恩、
何肇晏、吳子翔、黃一勝1,2
新光吳火獅紀念醫院 外科部 泌尿科1; 輔仁大學 醫學系2
Comparison of standard and tubeless percutaneous nephrolithotomy: Single surgeon initial experience
Chih-Yin Yeh1, Yi-Chia Lin1,2, Te-Fu Tsai1,2, Guang-Dar Juang, Chung-Hsin Yeh, Yi-Hong Cheng, Kuang-Yu Chou, Hong-En Chen, Cho-Yen Ho, Tzu-Hsiang Wu , Thomas I.S. Hwang1,2
Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital1
School of Medicine, Fu-Jen Catholic University2
Purpose: Tubeless percutaneous nephrolithotomy (PCNL) has been reported to be an effective surgical procedure for renal stones. The post-operative wound pain significant decreased in tubeless PCNL. Herein, we report our experience on the tubeless and standard PCNL.
Material and method: From January 2015 to March2017, 19 patients underwent PCNLsperformed by a single surgeon in our hospital. Group1patients underwent standard PCNLswith nephrostomy tube placement postoperatively andgroup 2 patients underwent tubeless PCNLs. The tubeless PCNL was performed with gelatin matrix (Floseal) packing in nephrostomy tract without nephrostomy tube placement at the end of operation. The demographics, perioperative parameters, complications and outcomes were collected and analyzed.
Result: Among the 19 patients, 9patients were in Group 1, 10werein group 2. The demographics were similar in these 2 groups including age, gender and co-morbidities. Peri-operative parameters including operative time and blood loss were comparable. There was no intra-operative complication in both groups. The stone free rate was high in group 2(80%) compared to group 1(56%).The hospitalstay was shorter in tubeless PCNL group compared to standard PCNL group. (3.1 vs. 5.3 days,p=0.015).The post-operative pain score was also lower in tubeless PCNL group (2.1 vs. 5.22,p=0.0005). The post-operative complication rate is similar in two groups (11% in group 1 and 10% in group 2, both complication were acute pyelonephritits).
Conclusion: Tubeless PCNL offers similar peri-operative parameter compared to standard PCNL. The hospital stay, post-operative wound pain and stone free rate is superior in tubeless PCNL group. Tubeless PCNL is a safe and effective procedure.