경피적 신쇄석술: 단일 병원 610례의 경험
Percutaneous Nephrolithotomy: A Single Center Experience of 610 Cases
권택민, 방정균, 김성철, 심명선, 하성헌, 홍범식, 박형근,
소속 상세정보
권택민 ( Kwon Taek-Min )
울산대학교 의과대학 비뇨기과학교실
방정균 ( Bang Jeong-Kyoon )
울산대학교 의과대학 비뇨기과학교실
김성철 ( Kim Seong-Chul )
울산대학교 의과대학 비뇨기과학교실
심명선 ( Shim Myung-sun )
울산대학교 의과대학 비뇨기과학교실
하성헌 ( Ha Seong-Heon )
울산대학교 의과대학 비뇨기과학교실
홍범식 ( Hong Bum-Sik )
울산대학교 의과대학 비뇨기과학교실
박형근 ( Park Hyung-Keun )
울산대학교 의과대학 비뇨기과학교실
KMID : 0358320090500070669
Abstract
Purpose: We performed this study to evaluate the outcomes and complications of percutaneous nephrolithotomy (PCNL) at a single institute with a large series.
Materials and Methods: We reviewed the medical records of 610 patients who underwent PCNL between March 1995 and June 2008 for staghorn calculi in 139 (22.8%), partial staghorn calculi in 104 (17.0%), renal pelvis stone in 222 (36.4%), proximal ureter calculi in 60 (9.8%), and calculi within a caliceal diverticulum in 85 (13.9%) patients. Stone-free status was defined as no visible residual calcification or remnant calcification smaller than 4 mm in diameter (clinically insignificant residual fragment) on a plain KUB (X-ray examination of the kidney, ureter, and bladder) image. Characteristics of the stones, operation time, stone-free rate, and complications were evaluated.
Results: Initial stone burden was 665.9±600.6 mm2. Average operation time was 103.2±58.6 minutes. The mean hospital stay was 7.9 days. The stone- free rate was 84.9%, and ancillary procedures were required in 66 patients (10.8%), including 34 (5.6%) second-look PCNL and 26 (4.3%) ureteroscopic procedures. In the univariate analysis for prediction of stone-free rate, hydronephrosis, stone type, stone composition, and stone burden were significant prognostic factors. In the multivariate analysis, initial stone burden was the only independent factor affecting the stone-free rate. Complications were found in 95 patients (16.1%), 5 (0.8%) of whom needed embolization due to bleeding and 23 (3.8%) of whom showed pleural complications.
Conclusions: PCNL is an effective method for the treatment of staghorn, large calyceal, and some upper ureteral stones with acceptable complication rates.
키워드
Percutaneous nephrolithotomy; Kidney calculi; Complications
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