| Objective: To compare the clinical effect of ultrasound guided minmally invasive percutaneous nephro Lithotomy with pneumatic lithotripsy and ultrasound guided minmally invasive percutaneous nephrolithotomy with holmium laser lithotripsy in the treatment of complicated upper ureteral calculi. Summarize the clinical experience and operation skill of minimally invasive percutaneous nephrolithotomy in treatment of complicated upper ureteral calculi.Methods: From January 2013 to December 2014 a total of 64 cases of complicated upper ureteral calculi patients in our hospital were divided into pneumatic lithotripsy(A group)and holmium laser lithotripsy(B group), Two groups were performed B ultrasound-guided minimally invasive percutaneous nephrolithotomy.There were 36 cases in A group, 20 cases were male, 16 cases were female; Ages ranged from 12 years old to 74 years old, average(50.3 ±13.1) years; The stones of 25 cases on the left side, the right side in 11 cases; The major diameter of Stones ranged from 12 mm to 40 mm, mean(20.8 ± 6.7) mm; 12 cases combined with renal calculi, Severe hydronephrosis( renal sinus separation in B ultrasound >30mm) in 26 cases; Preoperative urinary tract infection in 14 cases; ESWL failed in 8 cases. There were 28 cases in B group, 20 cases were male, 8 cases were female; Ages ranged from 24 years old to 61 years old, mean(47.2±8.9)years; The stones of 14 cases on the left side, the right side in14 cases; The major diameter of Stones ranged from 12 mm to 30 mm, mean(19.1±5.5) mm; 8 cases combined with renal calculi, Severe hydronephrosis( renal sinus separation in B ultrasound >30mm) in 21 cases; Preoperative urinary tract infection in 9 cases; ESWL failed in 3 cases. The operation time,postoperative hospitalization time, ureteral perforation during operation, postoperative fever, postoperative hematuria time, postoperative massive hemorrhage, clearance rate of calculus and tubeless rate of the two groups were compared and analysed after the surgery.Results: All patients were successfully performed percutaneous nephrolithotomy, No patient converted to open surgery, No massive hemorrhage during the operation, clearance rate of calculus of all patients was 95.3%,tubeless rate of all patients was 85.9%. In A group, 6 cases of ureteral perforation occurred during operation, residual stones occurred in 2cases after operation, 3 cases of postoperative fever occurred, postoperative massive hemorrhage in 1 case, the mean operation time was(69.3 ± 26.3) min, the mean postoperative hospitalization time was(7 ± 3.4) d, the mean postoperative hematuria time was(4.6 ± 2.4) d, clearance rate of calculus was 94.34%, tubeless rate was 83.3%. In B group,no ureteral perforation occurred, residual stones occurred in 1 case after operation, 1 case of postoperative fever occurred, no postoperative massive hemorrhage occurred,the mean operation time was(88.6 ± 34) min, the mean postoperative hospitalization time was(5.3 ± 1.8) d, the mean postoperative hematuria time(3.3 ± 1.8) d, clearance rate of calculus was 96.4%, tubeless rate was 89.3%. In operation time, group A was better than group B,in postoperative hospital stay, postoperative hematuria time and ureteral perforation, group B was better than group A, The differences were statistically significant(P<0.05). In clearance rate of calculus, tubeless rate, postoperative fever and postoperative massive hemorrhage.The differences of the two groups were not statistically significant(P>0.05).Conclusion: Ultrasound guided minmally invasive percutaneous nephrolithotomy lithotripsy for the treatment of complicated upper ureteral calculi has the advantage of safe, effective, high stone clearance rate, faster postoperative recovery and high tubeless rate.It can be used as the the first choice in the treatment of upper ureteral calculi. Compared to pneumatic lithotripsy, holmium laser lithotripsy in ultrasound guided percutaneous nephrolithotomy has smaller ureteral injury, better effect of the lithotripsy to hard stone, It can simultaneously treat polyp and stricture of ureter during the operation. It has unique advantage in the minimally invasive treatment of complicated upper ureteral calculi. |
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