使用持續性灌注(威爾普效應)藉由體外震波破壞腎下盞結石
陳一中1、林鼎博1、林文榮1、周永強1,2
馬偕紀念醫院 泌尿科1；馬偕醫學院；陽明醫學院2
The use of continuous irrigation (Whirlpool Effect) in the breakage of renal lower calyceal stones by extracorporeal shock wave lithotripsy.
Yi-Zhong Chen1, Ting-Po Lin 1, Allen W. Chiu 1, Yung-Chiong Chow 1, 2
Department of Urology, MacKay Memorial Hospital1; Mackay Medical College1;
School of Medican, National Yang-Ming University2
Introduction: Management for lower renal calyceal stones would be a nightmare for both patients and physicians. Many treatment options such extracorporeal shock wave lithotripsy (SWL), percutaneous nephrolithotomy, and flexible ureter renal scopy lithotripsy produce variable results. The previous study showed stone clearance rate in lower renal calyces was lower than middle and upper renal calyces and indicated that the location was an important factor due to post-SWL stone fragments accumulating recurrent stone in the lower calyces. We devised an innovative and effective method (Whirlpool effect) using continuous irrigation via normal saline infusion and suction during and after SWL to improve the stone clearance rate of lower calyceal stones.
Materials and methods: We performed SWL with continuous irrigation to 12 patients with refractory lower caliceal stones and previous SWL history. A Cobra(C-1) catheter (Cook, 5.5Fr, 80cm) and a No.5 ureteral catheter were inserted into renal pelvis via fiberocytocope. Location of the catheters was confirmed by portable plain film. Continuous irrigation with normal saline infusion by IVAC variable pressure infusion pump via Cobra catheter and continuous hemovac suction via No.5 ureteral catheter was performed during SWL and post SWL for a day. Radiological exams were performed to measure the stone burden before and after the procedure. We compared and analyzed the stone clearance rate (size and area), retreatment rate and side effects.
Results: There were significant difference between pre-and post-SWL stone size (1.27±0.40 vs. 0.62±0.56, p=0.001) and stone area (0.75±0.52vs. 0.4±0.52, p<0.0001). Stone free rate (stone size<0.4cm) was 50% (6/12). One patient suffered from left flank with fever and received further intervention. Retreatment rate was 33% (4/12). Average hospital day was 2.9 days.
Conclusion: The preliminary data shows that Whirlpool effect is an effective and safe method for renal lower caliceal stones. It may increase stone clearance rate comparing to traditional SWL. The experimental technique needs more prospective study to confirm the outcome.