經皮腎造瘻摘石術

Percutaneous Nephrolithotomy

許重權(Chung-Chuan Hsu) ； 王家槐(Jia-Hwia Wang) ； 周宜宏(Yi-Hong Chou) ； 吳峻吉(Chun-Chi Wu) ； 張遵(Tsuen Chang) ； 殷約翰(Jue-Hawn Yin) ； 陳光國(Kuang-Kuo Chen) ； 陳明村(Ming-Tsun Chen) ； 張心湜(Luke S. Chang)

《中華放射線醫學雜誌》 10卷2期 (1985/06) Pp. 122-130

摘要

經皮腎造瘻術首先由Goodwin於1955年引進後，現在已被廣泛地使用於上泌尿道阻塞病例之暫時性尿液引流。經皮腎造瘻術可在局部麻醉下很容易地操作且術後羅病率很低。近年來，經皮腎造瘻術也逐漸被廣泛地使用於經皮摘除上泌尿道結石。
從1984年5月至10月，台北榮總放射線部共有87個病人接受91次經皮腎造瘻術（其中三個病人兩側腎結石，一個病人為鹿角樣結石而作兩次經皮腎造瘻術）；有18個病人為復發性上泌尿道結石（以前曾接受傳統性腎結石或上部輸尿管結石摘除術）。術後，再由泌尿外科醫師以內視鏡或加上電極碎石術摘除腎結石或上部輸尿管結石。男性有57位，女性有30位。腎結石在右側有45例，在左側亦有45例（有一例鹿角樣結石曾作兩次經皮腎造瘻結石摘除）；上部輸尿管結石有12例。單一結石45例，多數結石39例，鹿角樣結石6例。
在91次經皮腎造瘻結石摘除術中，我們有89次成功地把結石摘除，成功率98%。在89次成功之病例中，泌尿外科醫師僅需一次即摘除者共有81例(91%)，分兩次摘除者有7例(8%)，而三次摘除者1例(1%)。未成功之2例後來以傳統性開刀方法摘除結石。術後發現有殘留結石者15例，估17%(15/89)。重要併發症有5例，包括嚴重出血（3例）及腎盂阻塞（2例）。其它輕微併發症包括暫時性血尿、發燒、脇疼痛及腸蠕動暫時靜止。
經皮腎造瘻結石摘除術逐漸被國內各大醫院所採用。隨材料及技術之改進，更進一步促進此術之發展。謹此把我們對於經皮腎造瘻結石摘除術之經驗提供給大家參考。

並列摘要

Since Goodwin and associates first introduced percutaneous nephrostomy (PCN) in 1955, it has now became the procedure of choice for the temporary decompression of the obstructed upper urinary tract. PCN is easily performed under local anesthesia and has a low morbidity. Recently, PCN is modified to permit percutaneous extraction of calculi of upper urinary tract.
From May to October, 1984, percutaneous nephrolithotomy was attempted on 91 kidneys in 87 patients at VGH, Taipei; in which 3 patients had bilateral renal stones and one patient had twice percutaneous nephrostomy for staghorn stone. The procedures were done by the cooperation of radiologists and urologists. Catheter placement was performed by radiologists and urologists did the stone extraction by endoscope and electrohydraulic lithotripsy. 18 patients have recurrent stone after previous conventional nephrolithotomy. There were 57 male and 30 female patients. The calculi was equally either on the right or left in 45 cases (one case was staghorn stone which received percutaneous nephrolithotomy two). 12 calculi located in the upper ureter. The calculis was single in 45, multiple in 39, and staghorn stone in 6.
Of the 91 percutaneous nephrolithotomies, 89 were successful in extraction of stone. The successful rate was 98%. Of the 89 successful percutaneous nephrolithotomies, extraction of stone could divided into (1) one session in 81 cases (91%). (2) two sessions in 7 cases (8%). (3) three sessions in 1 case (1%). The two cases which failed went into conventional nephrolithotomy. Residual stone occurred in 15 patients and occurence was 17% (15/89). Major complications included massive bleeding (3 cases) and renal pelvic obstruction (2 cases); and the incidence was 5% (5/9 1). Minor complications included transient hematuria, pyrexia, flank pain and ileus.
Based on our experiences, we believe, percutaneous nephrolithotomy represents a significant step forward in removal of renal stones and upper ureteral stones, especially with the continued improvement of materials and percutaneous techniques. Our experiences in percutaneous nephrolithotomy will be presented and discussed.