針對大於3公分以上腎結時使用無腎造廔管之經皮腎造廔取石手術以及逆行性軟式輸尿管鏡取石手術之比較
朱懿柏1、葉志胤1、吳子翔1 、何肇晏1、林宜佳1,2、蔡德甫1,2、陳宏恩1、
仇光宇1,2、鄭以弘1、葉忠信1,2、莊光達1,2、黃一勝1,2
1財團法人新光吳火獅紀念醫院外科部泌尿外科
2天主教輔仁大學醫學院泌尿外科
Comparison of percutaneous nephrolithotomy with tubeless method and retrograde intrarenal surgery in kidney stone over 3cm
Yi-Bo Chu1、Chih-Yin Yeh1、Tzu-Hsiang Wu1、Chao-YenHo1、Yi-Chia Lin1,2、Te-Fu Tsai1,2、
Hung-En Chen1、Kung-Yu Chou1,2、Yi-Hung Cheng1、Chung-Hsin Yeh1,2、
Guang-Dar Juang1,2、Thomas I.S. Hwang1,2
1 Division of Urology, Department of Surgery, Shin-Kong WHS Memorial Hospital, Taipei, Taiwan
2Department of Urology, Fu Jen Catholic University School of Medicine, Taipei, Taiwan
Purpose:
Percutaneous nephrolithotomy (PCNL) has been recommended as first line therapy for the renal calculi over 2cm. However, retrograde intrarenal surgery (RIRS) with flexible ureterorenoscopy (fURS) has been proved efficacy and safety for renal calculi. Currently, many studies showed similar outcome between PCNL and RIRS for the treatment of 2~3 cm kidney stone. In those studies, there was more complication, pain score, and hospital stay in PCNL group than RIRS. But recent studies also pointed out tubeless method would improve pain score and hospital stay compared to conventional nephrostomy method. Here, we analyzed 60 patients with over 3cm renal stone underwent PCNL with tubeless method and RIRS.
Materials and Methods:
From 2017July to 2019 February, 60 patients had renal stone over 3cm were enrolled in this study retrospectively. Among those patients, 30 patients underwent PCNL with tubeless method and other 30 patients with RIRS. Demographics, operation time, complication rate, pain score, hospital stay, 1-session stone-free rate were analyzed.
Results:
Among them, there was no difference in mean age between two groups (PCNL: 57.6 years old, RIRS: 58.17 years old, p= 0.86). Preoperative stone size was no significant difference. (PCNL: 4.53cm, RIRS: 4.47cm, p= 0.88).The complication rate (PCNL: 0.23, RIRS: 0.33, p= 0.39), hospital stay(PCNL: 4.46 days, RIRS: 4.06 days, p= 0.38) and pain score(PCNL: 3.4, RIRS: 3.03, p= 0.29)were all similar. Therefore, PCNL group had significant shorter operation time (PCNL: 110.5 minutes, RIRS: 178.3 minutes, p＜ 0.001) and better 1-session stone-free rate (PCNL: 40%, RIRS: 6.7%, p= 0.001) than RIRS group.
Conclusion:
The result showed that PCNL with tubeless method have superior 1-session stone-free rate and lower operation time in patients with over 3cm renal calculi than RIRS. In addition, complication rate, hospital stay, and pain scorewas equivalent between PCNL with tubeless method and RIRS.