Department of Urology, Naval Medical Center San Diego, San Diego, CA 92134, USA.
BJU Int. 2012 Dec;110(11 Pt C):E1048-52. doi: 10.1111/j.1464-410X.2012.11209.x. Epub 2012 Oct 9.
Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Small case series support the safety and efficacy of tubeless PCNL with fibrin sealant. However, there is a paucity of data from larger case series supporting this approach. To our knowledge, this is among the largest tubeless PCNL series. We found the use of fibrin sealant for tubeless PCNL was associated with excellent stone-free rates (approaching 90%), short hospitalisation, and low complication rates. Tubeless PCNL with nephrostomy tract fibrin sealant appears to be viable option for appropriately select patients.
• To report on our first 107 cases of tubeless percutaneous nephrolithotomy (PCNL) using fibrin sealant as a haemostatic agent within the access tract. PCNL is the preferred treatment for patients with large renal stones, and the tubeless technique with the use of fibrin sealant has recently gained popularity.
• We performed a retrospective review of single-access, PCNL cases performed without a nephrostomy tube from January 2002 to July 2008. • Nephrostomy tracts were sealed at the conclusion of each procedure with fibrin-containing haemostatic agents. • We evaluated demographic variables, tracked complications, and compared pre- and postoperative haemoglobin, haematocrit and creatinine levels. • On postoperative day 1 computed tomography was used to determine stone-free rates. • Student's t-test calculations were used to determine statistical significance at P ≤ 0.05.
• In all, 59 men and 48 women with a mean age of 43 years were included in the analysis of 107 cases. The mean stone size was 2.9 cm(2) and the average hospital stay was 1.07 days. • Pre- and postoperative changes in serum haemoglobin and serum creatinine were not statistically different. Postoperative haematocrit declined by a mean of 4.5% (P ≤ 0.05), but no patients required a transfusion. • Stone-free rates were 72% overall, and 90% when excluding patients with residual fragments of <4 mm. • Complications included seven asymptomatic subcapsular haematomas, one pseudoaneurysm requiring selective embolization, one urine leak, and five return visits to the emergency room for pain.
• The use of fibrin sealant in this large tubeless PCNL series was associated with favourable stone-free rates, short hospital stays, and low complication rates with no significant bleeding. • Tubeless PCNL with nephrostomy tract fibrin sealant appears to be a viable option for appropriately selected patients, but future randomised trials are warranted.
• 报告我们使用纤维蛋白密封剂作为经皮肾造瘘术（PCNL）通道内止血剂的首例 107 例无管经皮肾镜取石术（PCNL）。PCNL 是治疗大肾结石患者的首选方法，最近使用纤维蛋白密封剂的无管技术越来越受欢迎。
• 我们对 2002 年 1 月至 2008 年 7 月期间进行的单次通道、无肾造瘘管的 PCNL 病例进行了回顾性研究。• 在每个手术结束时，用含纤维蛋白的止血剂密封经皮肾造瘘管。• 我们评估了人口统计学变量，追踪了并发症，并比较了术前和术后血红蛋白、血细胞比容和肌酐水平。• 术后第 1 天使用计算机断层扫描确定结石清除率。• 使用学生 t 检验计算 P ≤ 0.05 时的统计学意义。
• 共纳入 107 例患者，其中 59 例男性，48 例女性，平均年龄为 43 岁。结石平均大小为 2.9cm²，平均住院时间为 1.07 天。• 术前和术后血清血红蛋白和血清肌酐的变化无统计学差异。术后血细胞比容平均下降 4.5%（P ≤ 0.05），但无患者需要输血。• 总体结石清除率为 72%，排除残留碎片<4mm 的患者后为 90%。• 并发症包括 7 例无症状的肾包膜下血肿、1 例需要选择性栓塞的假性动脉瘤、1 例尿漏和 5 例因疼痛返回急诊室就诊。
• 在这个大的无管经皮肾镜取石术系列中使用纤维蛋白密封剂与有利的结石清除率、短的住院时间和低的并发症发生率相关，且无明显出血。• 经皮肾造瘘术通道内纤维蛋白密封剂的无管技术似乎是一种适合选择的患者的可行选择，但需要未来的随机试验。
