免腎引流管合併抗凝血密封劑使用之經皮腎造廔取石術經驗
連繼志1、劉胤廷1、藍祺昀1、鄒凱亦1、胡書維1、高偉棠1、陳冠州1,2
1行政院衛生福利部雙和醫院 泌尿科
2臺北醫學大學醫學院醫學系泌尿學科
Experience of
Tubeless Percutaneous Nephrolithotomy with hemostatic sealant use
Chi-Chih Lien1, Yin-Ting Liu1, Chi-Yun Lan1, Kai-Yi Tzou1, Su-Wei Hu1, Wei-Tang Kao1, Kuan-Chou Chen1,2
1Department of Urology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
2Department of Urology, School of Medicine, College of Medicine, Taipei Medical University
Abstract
Introduction: Only few studies in Taiwan showed benefits of tubelss percutaneous nephrolithotomy (TPCNL) that were superior to the conventional percutaneous nephrolithotomy (PCNL). In our study, we would like to report our experience of performing tubeless PCNLs with hemostatic sealant (Flosaeal) in first 15 patients compare to conventional PCNL. Our object was to evaluate the safety and benefit of tubeless PCNL with Floseal use in all patients.
Materials and Methods: A retrospective review of the charts of patients who underwent PCNL at our institute from June 2014 to March 2015 was performed. The 30F Amplatz sheath system, occlusion balloon catheter, and Floseal as a sealant were applied to the tubless PCNL group. Demographic data, stone characteristics, perioperative course, and complication rates were collected and assessed.
Results: Out of 62 patients included, 15 patients received tubeless PCNL while 47 patients received conventional PCNL. There was no difference between these 2 groups regarding age, gender, BMI, pyuria, number of stone and stone location. The tubeless PCNL group had higher ASA (American Society of Anesthesiologists General Classification) score (p=0.04), shorter hospital stay (p =0.03), less post-operative pain score (p=0.02), less post-operative blood transfusion rate (p=0.002), less analgesia used (p=0.02) and less post-operative fever (p=0.01), when compared with conventional group. There were no significant differences in operating time, operative blood loss, stone free rate, decline of hemoglobin and postoperative ileus between these two groups.
Conclusion: Our report matches the previous reports regarding shorter hospital stay, less pain, analgesia used and less complication rates in tubeless PCNL with Floseal use.