Percutaneous Nephrolithotomy for the Treatment of Complete Staghorn Stones

經皮腎臟截石術治療完全鹿角結石

黃士維(Shi-Wei Huang) ； 張謙行(Chien-Hsing Chang) ； 王中敬(Chung-Jing Wang)

《臺灣泌尿科醫學會雜誌》 16卷4期 (2005/12) Pp. 169-174

摘要

OBJECTIVE: Treatment of complete staghorn stones is challenging for urologists because it is difficult to remove all of the stone. Percutaneous nephrolithotomy (PCNL) is suggested as the first-line treatment for complete staghorn stones by the American Urological Association. PCNL, first introduced to Taiwan in the late 1980s, is now widely used here. We present our experience in treating complete staghorn stones with PCNL at our institution.
MATERIALS and METHODS: Between July 1996 and December 2002, 234 patients with a complete staghorn stone underwent 249 PCNL procedures at our institution. The mean age was 52.4±12.8 (range, 14.8~77.3) years; 145 were males and 89 were females. The mean length of the stone was 6.1 (range, 2.1~8.6) cm, and the mean width of the stone was 5.0 (range, 2.0~6.8) cm. The operation was performed in a single stage, with biplanar C-arm assistance. Extracorporeal lithotripsy using a PCK lithotripter was scheduled on an outpatient basis, approximately 2 weeks after PCNL if residual stones were noted on a postoperative kidney, ureter, and bladder (KUB). A follow-up KUB check was taken 3 months after the operation to evaluate the stone-free status.
RESULTS: The stone-free rate, insignificant residual stone rate (＜4 mm), and residual stone rate at 3 months were 74.4%, 8.9%, and 16.7%, with a success rate of 83.3%. In total, 101 patients (43.1%) were successfully treated with PCNL alone. The mean operative time was 63.5 (range, 29~103) minutes. The mean hospital stay was 5.5 (range, 3~17) days. There was no mortality, and morbidity was minimal. The most-common complication was fever (23.1%); 3 patients experienced massive bleeding requiring a transfusion. One patient had an arteriovenous fistula and was successfully treated with angiographic embolization.
CONCLUSION: PCNL is a safe and feasible method for the treatment of complete staghorn stones, achieving a high success rate (83.3%) with minimal complications.

關鍵字

經皮腎截石術 ； 碎石 ； 腎結石

並列摘要

OBJECTIVE: Treatment of complete staghorn stones is challenging for urologists because it is difficult to remove all of the stone. Percutaneous nephrolithotomy (PCNL) is suggested as the first-line treatment for complete staghorn stones by the American Urological Association. PCNL, first introduced to Taiwan in the late 1980s, is now widely used here. We present our experience in treating complete staghorn stones with PCNL at our institution.
MATERIALS and METHODS: Between July 1996 and December 2002, 234 patients with a complete staghorn stone underwent 249 PCNL procedures at our institution. The mean age was 52.4±12.8 (range, 14.8~77.3) years; 145 were males and 89 were females. The mean length of the stone was 6.1 (range, 2.1~8.6) cm, and the mean width of the stone was 5.0 (range, 2.0~6.8) cm. The operation was performed in a single stage, with biplanar C-arm assistance. Extracorporeal lithotripsy using a PCK lithotripter was scheduled on an outpatient basis, approximately 2 weeks after PCNL if residual stones were noted on a postoperative kidney, ureter, and bladder (KUB). A follow-up KUB check was taken 3 months after the operation to evaluate the stone-free status.
RESULTS: The stone-free rate, insignificant residual stone rate (＜4 mm), and residual stone rate at 3 months were 74.4%, 8.9%, and 16.7%, with a success rate of 83.3%. In total, 101 patients (43.1%) were successfully treated with PCNL alone. The mean operative time was 63.5 (range, 29~103) minutes. The mean hospital stay was 5.5 (range, 3~17) days. There was no mortality, and morbidity was minimal. The most-common complication was fever (23.1%); 3 patients experienced massive bleeding requiring a transfusion. One patient had an arteriovenous fistula and was successfully treated with angiographic embolization.
CONCLUSION: PCNL is a safe and feasible method for the treatment of complete staghorn stones, achieving a high success rate (83.3%) with minimal complications.

並列關鍵字

percutaneous nephrolithotomy ； lithotripsy ； kidney calculus