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Analysis of Predictors of Operative Time During Percutaneous Nephrolithotomy
摘要
PURPOSE. Prolonged operative time is associated with prolonged anesthesia and presumably postoperative complications. Few studies had evaluated the impact of percutaneous nephrolithotomy (PCNL) on the operative time. The purpose of this study was to investigate the associations of duration of surgery with more variables including patient characteristics, stone burden, access tract, and perioperative complications. In our study, factors that influence operative time were analyzed. MATERIALS AND METHODS. This retrospective study contained 76 patients who received PCNL between December 2010 and February 2018 at a single institution. In this study, PCNL was carried out in two steps: percutaneous renal access and percutaneous nephrostomy (PCN) catheter placement, which were performed respectively by a radiologist under ultrasonographic and fluoroscopic guidance in the angiography-interventional room, then lithotomy, which was performed by a urologist in the operation room. Univariate and multivariate analyses were used to investigate the effects of variables on the duration for PCN catheter placement, operative time, and perioperative morbidity, including patient-, stone-, and procedure-related factors including age, sex, body mass index, skin-to-kidney distance, renal parenchymal thickness, stone size and location, and the access tract. Complications were identified and classified according to the Clavien-Dindo classification system. RESULTS. The average age was 55.74 ± 9.58 (32-76) years old and male-to-female ratio was 50:26. The mean stone size was 3.58 ± 2.26 (0.70-13.30) cm, the skin-to-kidney distance was 7.70 ± 1.76 (4.80-14.40) cm, and the mean renal parenchymal thickness was 16.0 ± 4.8 (3.0-28.0) mm. The mean PCN duration for catheter placement was 59.1 ± 35.1 (14.0-138.0) min, and the operation time was 183 ± 70 (50-453) min. Longer operative time was statistically associated with thin renal parenchyma (p = 0.010) but not skin-to-kidney distance (p = 0.070). Complications were classified as Clavien-Dindo grades I in 71 patients (93.4%), grade II in 3 patients (3.9%), and grade III in 2 patients (2.6%). CONCLUSION. Patients with thin renal parenchyma have longer operative time. The skin-to-kidney distance does not contribute to the longer operative time.
延伸閱讀
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