使用氧化再生纖維素(Surgecele)在無管路迷你經皮腎造廔取石術達到壓迫止血的技術
陳柏仲、周詠欽、沈正煌、鄭明進、林昌德、陳丕哲、賴韋宏、張舜凱
戴德森財團法人嘉義基督教醫院泌尿科
Pressure compression technique of the access tract with oxidized regenerated cellulose (surgicele) for tubeless mini-PCNL
Bo-Jung Chen, Yeong-Chin Jou, Cheng-Huang Shen, Ming-Chin Cheng,
Chang-Te Lin, Pi-Che Chen, Wei-hong Lai, Shun-Kai Jhang
Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose: To evaluate the safety and effectiveness of a new technique, which is pressure compression technique of the access tract with oxidized regenerated cellulose (Surgicele) for tubeless mini-PCNL
Materials and Methods: During August 2017 to September 2018, we reviewed a total of 81 patients underwent tubeless mini-PCNL. During surgery, after the stones were extracted and the double-J stent was placed antegradely. Pressure compression technique with Surgecele was used for hemostasis. This technique was placed the Surgecele through the access tract at the level of renal parenchyma, and compression hemostasis was achieved by counter-traction for 5 minutes between an 8Fr Foley catheter and a small sized dilators. The hospital course and postoperative complications were analyzed by retrospective review.
Results: Of the 81 patients, 52 patients were male and 29 patients were female. The mean age was 56.0 (25 to 81) years old. 50 patients were renal stones, 12 patients were ureteral stone and 19 patients were combination with renal and ureteral stones. The average stone size was 2.17 cm. The average operation time was 82.5 minutes. The overall stone free rate was 69.13%. Postoperative blood transfusion rate was 1.23%. Postoperative urinary tract infection was 9.88% and postoperative sepsis was 2.47%. The average hospital stay was 2.86 (2-8) days.
Conclusion: We introduced a pressure hemostasis technique by using Surgecele for access tract bleeding. Pressure compression technique with Surgecele is an alternative reasonable method to minimized hemorrhage complication for mini-tubeless PCNL.