單一造口經皮腎造瘻取石術處理不同結石大小探討
蕭夙娟、陳丕哲、鄭明進、周詠欽、沈正煌、林昌德、賴韋宏
嘉義基督教醫院 外科部 泌尿科
How the stone size can be performed with single access tract of percutaneous nephrolithotomy?
Shu-Chuan Hsiao, Pi-Che Chen, Ming-Chin Cheng, Yeong-Chin Jou, Cheng-Huang Shen, Chang-Te Lin, Wei-hong Lai
Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose: To evaluated the stone free on different stone size from PCNL single tract
Materials and Methods: Since January 2000 to June 2016, total 1182 PCNL were performed at our hospital with PCNL for larger renal stone, ≧ 2 cm. These procedures were all performed in one staged and single tract PCNL. The maximal stone size is defined the sum of total maximal stones length. Stone free was defined residual stone was less than 4mm on postoperative KUB. Infection was well control before operation. Analyzing the stone free rate along the stone size with 1cm length stepwise, 2-3 cm, 3-4cm, 4-5cm, 5-6cm and ≧6 cm . We also analyzed the two groups, stone free group(n=826) and not stone free group(n=356), on BMI, sex, comorbidities and operation time. The results of these patients were analyzed with retrospective chart review and software SPSS with a Mann-Whitney U test, b Chi-square test.
Results: The stone free and not free groups in our series data are not significant different on age (54.2 versus 55.2, p=0.205), BMI (25.8 versus 25.35, p=0.137) and comorbidities (27.6% versus 29.5%, p=0.507). A strong predictor of the stone free is the stone size (3.5 versus 5.82cm, p<0.001). On the results of stone free analyzed with the stones maximal length with 1 cm stepwise are, 2-3cm 93.2%, 3-4cm 79%, 4-5cm 67%, 5-6cm 39.4%, ≧6cm 24.3%. Not stone free group have definitive longer operation time (84.5 versus 96.4 minutes, p<0.001).
Conclusions: PCNL is a treatment of larger renal stone. In this procedure, single tract to achieve stone free is strongly relative with stone size(p<0.001). How the stone size is reasonable for single tract. In our series results proposed single tract have better result on stone size (maximal stone length) less than 5cm, offer greater than 60% stone free. If stone size greater than 5cm, single tract is not enough to offer good result on stone free.