迷你經皮腎取石術治療5公分結石
金介文 蔡政諭 林仁泰 余家政
高雄榮民總醫院外科部泌尿外科
Minipercutaneous nephrolithotomy for renal stones large than 5 cm
Chieh-wen Chin、Jeng-Yu Tsai、Jen-Tai Lin、Chia-Cheng Yu
Divsion of Urology, Depart of Surgery, Kaohsiung Veterans General Hospital
Purpose:
For renal stone, miniPCNL is a new treatment choice. The miniature nephroscopy offers a very slim, extremely easy-to-ureteroscope instrument for therapy of renal-pelvis and caliceal stone. It provides minimum renal trauma during PCNL. Here we present our initial experience in miniPCNL.
Materials and Methods:
A total of 12 patients (male: female=7:5) with stone length more than 5cm underwent mini-PCNL since 2017. Stone location (left: right=9:3) were renal pelvis with obstruction. Mean stone burden was 51.7 cm. Two-staged PCNL was done. Wolf miniPCNL instrument (14.5F outer sheath, 6Fr working channel) was used. For lithotripsy, A 30W Ho-Yag Laser was used. Stone was removed along 16~18Fr Amplatz sheath with water flow and forceps. For large stone burden, breaking the stone into pieces is more time saving than fragment stone into sand. Continuous water infusion via PCN tube also helps to wash the stone out.
Results:
Mean operative times were 133 minutes. No serious complication was noted post operation. Blood loss was minimal. No patient received blood transfusion perioperatively. Mean hospital stay was 5 days. Total stone free was established in 4 patients. Stone treatment had shift from traditional PCNL to miniPCNL after more experience on stone management and removal. Under current National Health Insurance, a single surgery cost of miniPCNL is 4509 NTD, which is much lower than cost of traditional PCNL and retrograde intrarenal surgery.
Conclusion:
MiniPCNL provided few traumas to kidney and minimum blood loss during operation. Operative time is longer comparing with traditional PCNL using ultrasound. Fewer intraoperative blood loss than PCNL is noted and the recovery time is rapid. For moderate stone burden within renal pelvis, miniPCNL is a safe and effective treatment choice