The Clinical Research Of Perfusion Circuit Created By Catheter Under The Ureteroscopy For The Treatment Of Ureteral Calculi

Objective:To explore the effectiveness of reducing the intrapelvic pressure with ureteroscopy by establishing the perfusion circuit applying catheterization with external negative pressure suction,and the effectiveness and security of holmium laser lithotripsy for ureteral calculi.Method:A perfusion circuit is created under the ureteroscopy by placing a catheterwith external negative pressure suction into the renal pelvis in its working channel.To establish a canine renal pelvis prefusion model,with which,measuring the different intrapelvic pressures under the changing perfusion pressures(30mmHg、100mmHg、150mmHg).Divide the model into two groups,one is applied catheterwith external negative pressure suction and the other is not.Both groups maintain the perfusion pressure at 30 mmHg,100mmHg and 150 mmHg,the data of renal pelvic pressure needs to be recorded every 5 seconds and 30 data has to be kept within each perfusion pressure.Make a comparison between the two groups on the changing data of the intrapelvic pressure.Combine this device with holmium laser lithotripsy and apply iton patients with ureteral calculi.To analyse the clinical data of 60 patients with ureteral calculi treated in our hospital from January 2018 to September 2018 and divide these patients into two groups according to different treatment methods,each group contains 30 cases.The observation group treats patients with the holmium laser lithotripsy through establishing the perfusion circuit by catheterization with external negative pressure suction under the ureteroscope,and the control group treats with the holmium laser lithotripsy through the normal ureteroscope.Make a comparison between these two groups of operative time,complications,and changes in WBC,PCT,and CRP before and 1 day after the surgery.Consequence:Under the perfusion pressure of 30 mmHg,100mmHg and 150 mmHg,the renal pelvic pressures of the group applied catheterwith external negative pressure suction were respectively(19.07±2.43)mmHg,(82.20±7.12)mmHg,(120.33±12.64)mmHg.The renal pelvic pressures of the control group were(25.97±3.75)mmHg,(93.13±6.40)mmHg,(133.57±12.54)mmHg.To evaluate the two sets of data,we know that the renal pelvic pressure of the group applied catheterwith external negative pressure suction was less than the normal group,and the difference was statistically significant.(p<0.05).All of the 60 surgeries were successfully performed with holmium laser lithotripsy through the ureteroscope.For the control group,the time of surgery was(41.87±6.76)min,the WBC、PCT、CRP before surgery were(9.58±4.57)×10E9/l,(1.10±3.85)ng/ml,(7.06±5.47)ng/l,1 day after the surgery were(13.88±5.69)×10E9/l,(3.67±4.75)ng/ml,(12.38±5.09)ng/l.As for the observation group,the time of surgery was(42.57±6.44)min,the WBC、PCT、CRP before surgery were(8.5±3.51)×10E9/l,(1.15±3.88)ng/ml,(6.67±5.37)ng/l,1 day after the surgery were(9.30±3.55)×10E9/l,(1.20±3.99)ng/ml,(7.03±5.74)ng/l.To analyse these two sets of data the time of the surgery,and the WBC、PCT、CRP before the surgery,the difference had no statistical significance(p>0.05).However,both the observation group and the control group had higherWBC 、PCT、CRP after the surgery(p<0.05);and 1d after the surgery,all of the WBC 、PCT、CRP of the observation group were lower than the control group.The difference was statistically significant.(p<0.05).The postoperative complications(perforation,fever,flank pain,calculus migration,infection)were analyzed in the two groups.The incident rate of complications in the observation group was lower than that in the control group.The difference was statistically significant.(p<0.05).Conclusion:The use of catheter external negative pressure suction to create a perfusion circuit under ureteroscopy can effectively reduce the pressure of the renal pelvis.Combined with holmium laser lithotripsy,this device is a safe and effective for the treatment of ureteral calculi.What is more,postoperative inflammatory response andthe incident rate of complications are lower than the conventional ureteroscopic holmium laser lithotripsy.