使用傾向分數配對分析在經皮腎鏡取石術中以電燒汽化與金屬擴張製造腎造廔口的比較
張殷綸1、江博暉1、鄭元佐1、李偉嘉1
1高雄長庚醫院泌尿科
Comparing tract creation using plasma vaporization with metal dilatation in percutaneous nephrolithotomy with propensity score matching
Yin-Lun Chang¹, Po-Hui Chiang¹, Yuan-Tso Cheng¹, Wei-Chia Lee¹
¹ M.D., Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Purpose: To share our seven-year experiences of a safe and effective method for tract creation in percutaneous nephrolithotomy (PCNL) with more cases.
Materials and Methods: We retrospectively reviewed the medical records of 230 patients who had undergone 244 PCNL procedures at our institute from May 2010 to December 2016 and divided into these plasma (n=130) and metal (n=114) groups. All patients underwent PCNL by either a bipolar resectoscope mounted with a plasma vaporization button electrode or metal dilatation for tract creation. Propensity score matching was applied to reduce selection bias and mimic randomization.
Results: After propensity score matching, the patients’ baseline characteristics mimicked randomization especially in the percentage of stone types in both groups, being all the same. There was no statistically significant difference in patients’ baseline characteristics. There were significantly shorter hospital stays (odds ratio (OR), 0.46; 95% confidence interval (CI), 0.32 to 0.66; P<0.001) and shorter average operating time (odds ratio (OR), 0.98; 95% confidence interval (CI), 0.97 to 0.99; P<0.001) in the plasma vaporization group. Neither before nor after the propensity score matching, were there statistically significant differences between the groups in 24-h postoperative haematocrit and haemoglobin drop, 24-h postoperative eGFR change, the rate of residual fragments <4 mm, postoperative complications, and time of need for pain control.
Conclusions: The plasma vaporization technique is a safe and effective method for creating the nephrostomy tract for PCNL, based on shorter postoperative stay, less operating time, zero blood transfusion rate, acceptable stone free rate, and no major complications.