兩階段多孔道微創經皮腎造瘻碎石取石手術來處理完全鹿角結石: 個案經驗分享
曾文歆、李高漢、陳致豪、劉建良、黃冠華
奇美醫療財團法人奇美醫學中心 外科部 泌尿外科
Two-stage Multiple-tract Minipercutaneous Nephrolithotomy for the Treatment of Complete Staghorn Stones: a Case Experience
Wen-Hsin Tseng、Kau-Han Lee、Zhi-Hao Chen、Chien-Liang Liu、Steven K. Huang
Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
Purpose:
Percutaneous nephrolithotomy (PCNL) is the standard of care for the management of large renal stones. Multiple-tract mini-PCNL is commonly performed to manage complete staghorn stones in Chi Mei Medical Center. Nevertheless, two-stage PCNL is required to treat residual renal stone fragments. Two-stage multiple-tract mini-PCNL is performed for the treatment of complete staghorn stones that prefer treatment approach for cases with easy bleeding, sepsis, and systemic injury with excessive angulation which prolongs operation time.
Case presentation:
A 49-year-old female who denied any systemic disease presented at the emergency room for sudden-onset right flank pain on 2019/01/25. CT revealed a right upper-third ureteral stone with a size of approximately 0.5 cm and left renal complete staghorn stones (Fig1). The patient underwent an emergency surgical installation of a right URS-SM+ bilateral JJ stent (Fig2) and received left one-stage multiple-tract mini-PCNL on 2019/02/11(2 tracts; OP time: 4 h 30 mins)(Fig3.). She underwent left two-stage multiple-tract mini-PCNL until 2019/03/04 (5 tracts; OP time: 1 h 30 mins). The JJ stent was removed on 2019/03/20 (Fig4). The patient was stone free (Fig5) and did not require blood transfusion. Acute kidney injury was not observed.
Conclusion:
Multiple-tract mini-PCNL is an efficient and safe approach for manipulating kidney staghorn stones. However, the treatment of some cases with complete staghorn stones through two-stage PCNL should be planned. Otherwise, the first course of PCNL may be discontinued because of bleeding, collecting-system perforation, prolonged operative time, or sepsis. In conclusion, two-stage multiple-tract mini-PCNL for the treatment of complete staghorn stones reduces complications and improves stone clearance rates.
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Fig1. Left renal complete staghorn stones
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Fig2.Postinsertion of a right URS-SM+ bilateral JJ stent
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Fig3.Post-one-stage multiple-tract
mini-PCNL
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Fig4.Post-two-stage multiple-tract mini-PCNL
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Fig 5. Final KUB: stone free
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