Analysis Of Curative Effect About Three Minimally Invasive Surgery Methods In Treating Kidney Stone

Objective: To compare the therapeutic effect of extracorporeal shock-wave lithotripsy(ESWL),flexibleureteroscopy1ithotripsic(FURL)and percutaneous nephrolithotomy(PCNL)in treating patients with kidney stone.Methods: From January 2013 to December 2016,a total of 136 cases with kidney stone were retrospective analyzed.All the cases were diagnosed by ultrasound of urinary system,plain film of kidney-ureter-bladder(KUB),intravenous pyelography(IVP)or computed tomography(CT).The 136 cases Were divided into three groups,ESWL(36),FURL(62),and PCNL(38).The average age of ESWL,FURL and PCNL respectively were 43.61±13.42,43.68±13.1 and 44.37±13.65.The mean diameter of stone respectively were 12.08±2.56 mm,18.89±2.58 mm,25.74±4.11 mm.According to whether the diameter less than 20 mm,we divided FURL into two groups,and then respectively compared with ESWL and PCNL.Operative time,intraoperatve blood loss,stone free rate,postoperative hospitalization and postoperative complications were compared to the curative effect of three methods in treating kidney stone with different sizes.Results: In the group with diameter <20 mm,the operative time(t=-7.40,P<0.01)and postoperative hospitalization(t=-3.14,P=0.003)of ESWL were shorter than FURL.Postoperative infection were happened in 3 cases in ESWL group(total 36 cases),with infection rate 8.33%.While 4 cases postoperative infection happened in FURL group(total 30 cases),with infection rate 13.33%.There was no significant difference in two groups.(?2=0.43,P=0.51).Residual stone occur in 2 cases one month after the operation in ESWL group(total 36 cases),with stone free rate 94.44%.While 2 cases residual stone happened in FURL group(total 30 cases),with stone free rate 93.33%.There was no significant difference in two groups too.(?2=0.04,P=0.85).The operative time In FURL group(diameter ?20 mm)were longer than in PCNL group(t=2.39 P=0.02),the intraoperatve blood loss In FURL group(diameter ?20 mm)were less than in PCNL(t=-6.27 P<0.01),while the postoperative hospitalization In FURL group(diameter ?20 mm)shorter than in PCNL(t=-8.46 P<0.01).All the above result have statistical difference.Postoperative infection were happened in 5 cases in FURL group(total 32cases),with infection rate 15.63%.While 7 cases postoperative infection happened in PCNL group(total 38 cases),with infection rate 18.42%.There was no significant difference in two groups(?2=0.096,P=0.76).Residual stone occur in 9 cases one month after the operation in FURL group(total 32cases),with stone free rate 71.88%.While 3 cases residual stone happened in PCNL group(total 38 cases),with stone free rate 92.11%.The stone free rate in PCNL higher than in FRUL,have statistical difference(?2=5.01,P=0.03).Conclusions: ESWL is one of the main methods in treating kidney stone with diameter <20 mm,has the advantage of safe,effective,convenient and cheap.When treating kidney stone with diameter <20 mm,FURL has higher stone free rate,shorter postoperative hospitalization,quicker recovery and lower incidence rate of complication.Especially for the patients who failed in location and lithotripsy by ESWL,postoperative residual by ESWL and PCNL,and kidney stone with diameter <20 mm.As for kidney stone with diameter ? 20 mm,PCNL can be first choice because of short operative time,high stone free rate,though a certain extent risk of hemorrhage.However,as for the patients with coagulopathy,anatomical deformities and renal insufficiency,or patients have difficult in puncture,FURL would be a main measure.