| ObjectiveAlong with the technological development of urological endoscopy and holmium laser,FURL has increasingly been drawn our attention in clinic within its advances in security,super minimal invasion,efficiency and quick postoperative recovery.Our study aims to discuss the main factors influencing the treatment results and complications of FURL and whether a ureteral stent is indispensable preoperatively through the following retrospective summary and analysis,which were the data of comparably grouped results of treatment and complications concluded from patients.MethodsWe collected and classify the data of patients who were offered FURL in the Department of the Second Affiliated Hospital of Nanchang University between January 2014 and October 2014.The data including both laboratory tests and physical examination,which were about routine blood and urine analysis,clotting function,blood electrolytes,liver and kidney function,middle urine culturing,urinary ultrasonography,intravenous urography,urinary systemic CT scan,respectively.All enrolled patients signed the informed consent and agreed with the treatment plan of FURL voluntarily.We reviewed the postoperative conditions of D-J tube position and the effects of initial operative outcomes of FURL by kidney ureter bladder X-ray plain.Then the data of routine blood analysis and blood electrolytes were also reviewed after operation 1-2 days.Besides that,we reviewed the data of SFR(Stone Free Rate)by kidney ureter bladder X-ray plain after operation 1 month and arranged the patients with residual stones to be further treated or got the D-J stent out,then observed them and followed up.SPSS19.0 software was utilized for analyzing the collected data from enrolled patients.Patients’ age,body mass index,maximum diameter of stone,time of lithotomy,length of hospital staying were described in measurement data recorded as sx ±.In addition,RFR and incidence rate of SIRS(Systemic Inflammatory Response Syndrome)were described in percentum.If P<0.05,we would think the differences are statistically significant.According to whether the stones removed or not and the occurrence of SIRS or not,group were divided.We analyzed the univariate numerical value and influence of various factors with Chi-square Test and t Test.we selected appreciate independent variables,made multivariate Logistic regression analysis and deeply screened of influence factors of SFRS and the risk of SIRS in postoperative FURL.Results1.The first completion phase of patients with FURL was 91.4%(391/428),and 1 month postoperative SFR was 72.12%,postoperative incidence rate of SIRS was 8.18%,respectively.2.The patients were divided into two groups according to whether the calculi were moved to totally.The volume of the non-moved totally group was huger than that of totally moved totally group(P<0.001).The SFR of the group with calculus diameter >2cm was significantly lower than that of diameter ≤2cm group(P<0.001).We used multivariate Logistic regression analysis to further screen independent factors of SFR.The data suggested that the volume of calculus(OR=8.636,95%CI:4.594 ~16.236)and the lower calculus(OR=8.914,95%CI:4.463 ~21.923)were enrolled.3.According to the standard whether the patients suffered with SIRS,we divided them into two groups.The proportion of SIRS in female patients was significantly higher than that in male patients(P<0.001).The volume of renal calculi in SIRS group was significantly higher than that in non-SIRS group(P=0.004).The proportion of the diameter >2cm was significantly higher than that of diameter <2cm(P<0.001).The proportion of patients suffering SIRS of calculus post-operation in isolated kidney was significantly higher than that in the other patients(P=0.040).The gravel time and operation time of renal calculi in SIRS group was significantly longer than that in non-SIRS group(P<0.001).We used multivariate Logistic regression analysis to further screen independent factors of SIRS.The data suggested that the volume of calculus(OR=9.892,95CI%:4.463 ~21.923),time of gravel(OR=2.531,95CI%:1.318~5.957)and calculi in isolated kidney(OR=4.632,95CI%:2.892 ~11.254).4.Renal pelvis funnel angle of totally moved totally group in lower calyxes post-operation was significantly bigger than that of totally non-moved totally group(P<0.001).According to the standard of renal pelvis funnel angle was 45°,the SFR was significantly higher in ≥45°group than that in <45°group(P=0.021).Conclusions1.FURL is a safe and effective treatment method of renal calculi within its advances in higher SFR and lower incurrence of complications.2.Since non-pre-dilation D-J stent has successful operation rate of FURL as high as 91.4% without resulting in catheter discomfort,less complications。3.The volume of renal calculi and renal pelvis funnel angle of lower renal calyxes both are the novel influence factors of SFR.4.The volume of renal calculi,the time of gravel are the risk factors of SIRS occurring after FURL. |
PDF Full Text Request