| [Baokground]To evaluate the efficacy and safety of single-channel minimally invasive percutaneous nephrolithotomy combined with retrograde ureteroscopy for the treatment of complicated renal calculi.[Methods]This study reviewed 140 patients with unilateral complicated renal calculi diagnosed and treated in the Department of Urology,Qianfoshan Hospital,Shandong Province from March 2013 to December 2016.Access relevant clinical data,and conduct statistical analysis on general basic information and clinical treatment effects of patients.The study was divided into three groups according to the actual situation of the operation.Group A was treated with single-channel minimally invasive percutaneous nephrolithotomy and retrograde ureteroscopy with laser lithotripsy(45 cases).Group B was treated with single-channel minimally invasive percutaneous kidney.Puncture stone removal(40 cases),group C was retrograde ureteroscopy with laser lithotripsy(55 cases),comparative study of three groups of patients with surgical safety(intraoperative blood loss,postoperative complications)and effectiveness(Phase I Surgical stone clearance rate,operation time,postoperative hospital stay days).[Results]This study included 140 adult patients with unilateral complicated renal calculi:45 patients in group A,40 patients in group B,and 55 patients in group C.(1)In terms of surgical safety,the amount of intraoperative blood loss was 67.98±13.52 ml in group A,116.30±9.94 ml in group B,and 10.31±2.86 ml in group C.Group B was much more than group A and C,group C.The amount of bleeding was the least,and the difference between the three groups was significant(p<0.05).(2)In terms of surgical effectiveness,the stone clearance rate of the first-stage operation was 97.8%in group A,77.5%in group B,and 78.2%in group C.Group A was much higher than group B and group C,group B and C.There was also a difference in the primary clearance rate between the two groups,but the difference was not significant,no statistical significance(p>0.05).In terms of operation time,group A was 63.27±8.60 min,group B was 73.83±6.34 min,group C was 54.87±7.18 min,group A was shorter than group B,and was higher than group C,group B was longer than group C,and the difference was statistically significant(p<0.05).The postoperative hospital stay was 7.36±1.77 days in group A,9.95±1.89 days in group B,and 4.33±1.55 days in group C.The length of hospital stay was the shortest in group C,and the length of hospitalization in group B was the longest,with significant differences(p<0.05).(3)Surgical safety,postoperative complications in three groups of patients,postoperative pain(VAS score 0-10,VAS>0 as a statistical standard in this study),postoperative fever(body temperature ≥38.5℃),postoperative bleeding Data statistics.Among them,postoperative pain patients,13 patients in group A(28.9%),12 patients in group B(30.0%),and 4 patients in group C(7.3%),the number of cases in group C was the least,the difference was significant,and statistically significant(p<0.05).After operation,4 patients(8.9%)in group A,3 patients(7.5%)in group B,and 13 patients(23.6%)in group C had fever,and 1 patient in group A and group B had positive urine culture results.Group C 9 cases were confirmed to be urinary tract infections,the number of fever patients was significantly higher than that of group A and group B,the difference was statistically significant(p<0.05).In terms of postoperative bleeding,9 patients(20%)in group A,18 patients(45%)in group B,and 2 patients(23.6%)in group C,of which 8 patients in group A did not intervene and improved themselves.1 case was improved on the 3rd day after clamping the renal fistula,and 2 cases in group B were treated with renal fistula clamp and intravenous hemostatic(injectable hemagglutinase).After bed rest,1 case was severely hemorrhagic.Arterial embolization was cured,and there was no serious bleeding in group C.The number of postoperative bleeding in group B was significantly higher than that in group A and C,and the difference was statistically significant(p<0.05).[Conclusion]Under the condition that patients can tolerate surgery,the use of prone position,combined with single-channel MPCNL and RIRS,is more effective than single surgery in the treatment of complex kidney stones,providing a new treatment idea.Is expected to be an effective treatment. |
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