a dv a,uvIufigtufluu Original Article

n r : Yn s r fi al u'l sr sie s n r : r o r v r r.i r u fi e m rYs'l ulr s r{ u r u r a sa : : nf iJ : v u r Yn d

Treatment of Renal Stones by Percutaneous Nephrolithotomy

(PCNL) in Sawanpracharak Hospital

AIvt:s3fr tJtvonqt n.u. Songwut Prasopsuk M.D.

n{rl'rrufraun::tJ Department of Surgery

I:snsrurooa::nfiJ:vurYnd sawanpracharak Hospitaldun:oa::ri Nakhorn Sawan

da v dfl?::nil:v5t:nu[?ucn:ani-AvvrJYt 6 flrJUil 3 nilU',luu-fi1.{?1fiil 2552

Sawanpracharak Medical Journal

VoLo No.a September-December zoog

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187 Treatrnent of Renal stones by Percuraneous Nephrclithotomy (rcNL) in Sawmpmchrak Hospital -r-|fi O aulufi 3 n.iJ.-fi.Fl. 2552

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Abstract

Obiective

Setting

Design

Subiects

Method

To evaluate and effectiveness and result of removal of renal stones by

percutaneous nephrolithotomy(PCNl) in Sawanpracharak Hospital

Department of surgery, Sawanpracharak Hospital

Retrospective descriptive comparative study

80 renal stone patients were treated by PCNL at Sawanpracharak

hospital between July 2OO7 and July 2009

The date of surgery, gender, age, stone size, operative time, results,

complications and days of hospital stay were collected from medical

record. Then the patients were divided in two groups the by date of

surgery the first 40 and the next 40 patients. The data between two

groups were compared using t-test or Mann*Whitney U and Chi-square

test with statistical significance at P < 0.05

d, v a6l?::FtllTs{1:fl 14t?td',t: flff?fi ilrcaflqt 188

Results

Conclusion :

Key words :

The mean age was 48.5 12.1 years, 43(53.8%) males and37(46.2%)

females. 2O(25y") small 55(68.8%) rnedium and 5(6.2%) large renal

calculi were included in this study. The average operative time was

99 35.0 minutes. The complications included 5(6.2"/"\ pleural cavity

perforations with hydrothorax,lS(22.5%) patients required blood transfusion,

3(3.8%) immediate conversion to open surgery and 1(1 .2"/") had urosepsis.

The overall stone free rate was 62(77.5%).

Comparing between the first and second groups : average operative

time was 113 40.6 and 86 22.6 minutes, hospital staywas 6.4 5.6

and 4.4 4.1 days, overall complications were 17(42.5%) and 6(15.0%),

and stone free rate was 62.5% and 92.5"/"

PCNL is effective and save procedure for removal of renal calculi.

The complication rate is low and mostly correctable. However, to obtain

better result. Knowledge and surgical skills are required.

Percutaneous nephrolithotomy(PCNL)

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nr:Ynsrfi 'r1u'lod:unr:rorc:rirufi rilfi r 1uI:rrorrraar::rir.l:vmind1 91 Tmtment of Renal stones by Percutmeols rephrolithotomy (PCNL) in sawanprachilak Hospital fld O auiufi 3 n.fl.-o.n. 2552

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7. Botoca M, Boiborean P, Bucuras V, Herman l, Minciu R, Claici D. et al. The

learning curve in PCNL; do individual skills prevail over experience? European

Urology Supplements 2006; 5: 147.

c.vcdxt:nu:3fl1:nur?t6t1: ilfi?6 il:esilffi 192

i e &\et1T1.,rfi t {aruavr'rtrj{

narya (N = Bo) o'rueultoaarl

11,{Fl

t1?tA

?16U.,:

arq 6D ; mean (SD)or-'

nlumu{?oitu2ll 9LFI{1EI

IL0t?t?1

jdun?a\:u?

pelvic stone

calyceal stone

staghorn stone

upper ureteric stonej

?rulFtto{u2It

uaetfl?1 2.5 tquntilnT

2.5 - 5 lquattlnr

Mnn'i1 5 r{uaLilCIr?

43(53.8)

37(46.2)

48.5(12.1)

31(38.8)

4e(61.2)

43(53.8)

16(20.0)

20(25.0)

1(1.2)

20(25.0)

55(68.8)

5(6.2)

nr:Ynu rfi :1u'lndrunr:rors:airuR'rmir 1rl:rnurrrna:::rirj:srrind ) -)1 93 Treatment of Renal Stones by Pscutaneous Nepbrolithotomy (PCNL) in Sawanprrchrak Hospital Un 6 OUUn 3 n.g.-o.n. 2552

rnfl{fi 2 n1:inu1 rnszuanl:fnu1

{aryn (N = 80) ,iruruliauar;

o 'iFl1Ltfiu{?lto1s (tract access)

upper calyx

lower calyx

rrnrfflfiniroior (u1fi) ; mean (SD)6tva

n1:[]ltaaFr

kifrar'lfrrdoor

t gfin

2 gfin

3 gfior

4 gfin

r*uuaul:rnEj1u1a ({u) ; mean (sD)

R1?sLrl',!TnfrOU

urinary extravasations

bleeding with shock

hydrothorax

failed PCNL

neprocutaneous fistula

cardinc arrest

sepsis

,Jnn1:inu1

stone free

CIRF*

retain stone

36(45.0)

44(55.0)

ee.0(35.0)

62(77.5)

e(11.3)

7(8.8)

1(1.2)

1(1.2)

5.4(4.e)

7(8.8)

6(7.5)

5(6.3)

2(2.5)

2(2.5)

1(1"3)

1(1.3)

62(77.5)

2(2.5)

16(20.0)

. Clinical insignificant residual fragment

d?TTFtu:vU1:nUt?t61: il3.r?6 ilrcrrilqfl 194

Fr1r1.,lfi 3 riliau rfi sufraernvirtrl n1:inu1 ras,{nn1:inu1a

v?a3JA{

40 Fturr:nv

40 nUfiA.]

druruliaunr;,iruruliaaar;P value

tiln

41fl

(t1fl : fi€.0)

(fll); mean (SD)

n'rumil.,:tro.:fir (lorfrru : lmmr;

tfin'uatfirpelvic stone

stag horn stone

calyceal stone

upper ureter;

flu1nfla{u?9tauaflfll1 2.5 LflUprtuFr:

2.s - s rfluar:Jnr

rurnn'ir 5 lf,ufiLeJrr:

" ,iFt1ttfi u{Yttarr (tract access)

upper calp<

lower calyx

rru.dLffLrn'r:drn-or1urfi); mean (sD)a9a

fl1:lfitaa6t

l{ma'.o rir n-n (riu) ; median (range)

siruru{'uuaul:.:rnlEl'tura({u); mean (SD)

fl1?rLLm:flfrAU

,{nn1Tfnu't

stone free

CIRF#

retain slone

21 :19

47.8(12.5)

15:25

22(55.0)

12(30.0)

6(15.0)

0

7(17.5)

30(75.0)

3(7.5)

17(42.5)

23(57.5)

113(40.6)

10(25.0)

2.0(0-e)

6.4(5.6)

18(45.0)

25(62.5)

1(2.5)

14(35.0)

22: 18

4e.1(11.8)

16 :24

21(52.5)

8(20.0)

10(25.0)

1(2.5)

13(32.5)

25(62.5)

2(5.0)

1e(47.5)

21(52.5)

86(22.6)

8(20.0)

1.5(0-8)

4.4(4.1)

6(15.0)

37(e2.5)

1(2.5)

2(5.0)

0.82

0.747

0.818

o.420

0.292

0.653

0.001*

o.677

0.133@

0.003.

0.003.

0.003*

# Clinical insignificant residual fragment

@ Mann - Whitney U testdV O V AA* tJuudlnflml{dna