Nghiên Cứu Y Học
THE PERCUTANEOUS NEPHROLITHOTOMY: EARLY RESULTS OF 50 CASES AT BINH DAN HOSPITAL
Bấm tải bài viết
Tạp chí Y học Thành phố Hồ Chí Minh,
7(1):66. DOI
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17
Tác giả
Nguyễn Phúc Cẩm Hoàng , Đào Quang Oánh, Lê Sỹ Hùng, Nguyễn Ngọc Tiến, Trần Thượng Phong
Tóm tắt
Các tác giả trình bày kết quả tán sỏi qua da cho 50 trường hợp tại Bệnh viện Bình dân bằng máy Lithoclast. Trong số này có 20 trường hợp (40%) là sỏi tái phát, 21 trường hợp là sỏi bể thận (42%), 6 trường hợp (12%) là sỏi san hô và 1 trường hợp (2%) là sỏi san hô toàn phần. Kích thước sỏi không quá 45mm. Tỷ lệ sạch sỏi là 54%, tỷ lệ sót sỏi quan trọng là 16%, sót sỏi không quan trọng là 30%. Biến chứng gồm có 5 trường hợp chảy máu lúc mổ, 3 trường hợp chảy máu sau mổ, 4 trường hợp nhiểm trùng huyết. Thời gian name viện trung bình là 6,36 ngày. Kết quả trên cũng tương hợp với các kết quả của nước ngoài
Abstract
Purpose: The percutaneous nephrolithotomy (PCNL) has become a rational and feasible option in the strategy of treating nephrolithiasis (renal stones, UPJ stones) at Binh Dan hospital since 5 years. This paper reviews early results of 50 latest cases of PCNL performed at The Department of Urology B, Binh Dan hospital from November 2001 to November 2002. Materials and Methods: last year we have performed more than 50 cases of PCNL but in this paper we concentrate on 50 latest cases of pelvic and UPJ stones, from simple renal stones to staghorn calculi or partial staghorn calculi (7 cases). We performed a sequential dilatation of a tract into the renal cavity using the Alken's telescopic dilators, disintergration of stones using exclusively the Swiss Lithoclast, and removal of fragments using the forceps. For early evaluation of the operation, we perform a KUB on discharge. Results: there were 28 male (56%) and 22 (44%) female patients, aged from 23 to 70, average 44.7. Twenty cases of recurrent or residual stones (40%). There were 27 pelvis-shaped stones (54%), 6 partial staghorn stones (12%), 1 complete staghorn stone (2%), 16 patients (32%) with multiform stones. Stone size varies from 4 - 42mm, average 34.3mm. Mean stone per patient was 2.68. Stone topography: 1 mid-pole stone (2%), 12 lower-pole stones (24%), 21 pelvic stones (42%), 2 UPJ stones (4%), 1 lower-pole stone in an obstructed hydro-calyx (2%) (recurrent stone) and 13 patients (26%) with multiple stones. Pre-op IVU revealed 5 cases (10%) with no pyelocaliceal dilations, 21 cases (42%) with mild dilations, 18 cases (36%) with moderate dilations, and 6 cases (12%) with severe dilations. Good renal function: 43 (86%), fair renal function: 3 (6%), bad renal function: 4 (8%). Outcome of operation: Mean operation duration= 98.5 minutes (55-180 minutes), mean blood loss = 177.02 mL, 3 cases (6%) required transfusion. There were 5 per-op hemorrhagic incidents (10%). Post-op complications comprise 11 hyperthermia (22%), 4 sepsis (8%), 6 UTI (12%), 1 re-absorption syndrome (2%), 4 secondary hematuria (8%). Upon discharge, 27 patients (54%) were stone-free, 15 (30%) with insignificant residual fragments (good result = 84%). 8 cases (16%) were with important residual fragments (failure = 16%). In 7 cases of staghorn calculi, there were 4 good results, acceptable results and 1 failure. Mean post-op admission time = 6.36 days, mean analgesics administration = 3.62 days. Most of the patients experienced little pain (62%) and only 2 patients (4%) had much pain. Conclusions: these results, in comparison with those of foreign authors and those of Vu Van Ty (April 2001), are encouraging in terms of gross final results with shorter operation duration, encouraging results in staghorn stones, shorter post-op admission time, no severe complications despite the pretty high rate of post-op infection. Transfusion rate was acceptable. If more materials are invested, bigger staghorn stones would become candidates for the PCNL and the operation would become routine in very near future.
