| ObjectiveTo investigate and compare the clinical efficacy and safety of microchannel percutaneous nephrolithotripsy(MPCNL)and flexible ureteroscopic lithotripsy(FURL)combined with holmium laser in the treatment of upper urinary calculi with a diameter of 2-2.5 cm.MethodFrom April 2016 to July 2018,Clinical data of 110 patients with upper urinary calculi treated by MPCNL or FURL combined with holmium laser were collected.The length and diameter of the stones were 2-2.5 cm.110 patients were divided into two groups:MPCNL group(n=55)and FURL group(n=55).In the FURL group,ureteral Double-J-catheter were used to indwell urine for 2-4 weeks before surgery.Indicators for collecting and analyzing comparisons included preoperative basic data,operation time,intraoperative and postoperative blood transfusion rate and hemoglobin decline,postoperative total hospitalization time,stone clearance rate(within 1 week after surgery,1 month after surgery,3 months after surgery),postoperative complications(Clavien-Dindo grade ? or above),inflammatory indicators(white blood cell count(WBC),procalcitonin(PCT)),inflammatory indicators of trauma(C-reactive protein(CRP)),renal function indicators(urea nitrogen(BUN),serum creatinine(Scr)),etc.ResultComparison between MPCNL group and FURL group:There was no significant difference between the two groups in age,sex ratio,hydronephrosis,stone CT value,stone size and stone distribution,P>0.05;There was no significant difference in operation time,(83.2±24.6)vs(85.2±20.4)min,P>0.05;The intraoperative and postoperative blood transfusion rate was significantly increased in the MPCNL group,(10.91%(6/55)vs 0%(0/55),P<0.05;Postoperative decreased hemoglobin was significantly increased in the MPCNL group,(12.3±3.4)vs(2.4±0.9)g/L,P<0.05;There was no significant difference in PCT and WBC between the two groups after surgery,(PCT(1.85±0.53)vs(1.77±0.50)ug/L,WBC(10.42±3.47)vs(10.18±2.28)109/L),P>0.05;Postoperative CRP index MPCNL group was significantly increased,(17.4±2.5)vs(7.1±3.5)mg/L,P<0.05;Preoperative and postoperative changes in BUN and Scr were not significant,with no statistical difference,P>0.05;Complications(Clavien-Dindo grade ? or above)were significantly increased in the MPCNL group,18.18%(10/55)vs 1.82%(1/55),P<0.05;The total postoperative hospitalization time in MPCNL group was significantly prolonged,(8.6± 1.9)vs(4.1 ± 1.8),P<0.05;The total cost of treatment in MPCNL group was significantly lower,(17653.2±3903.8)vs(24493.9±4368.9),P<0.05;The stone clearance rate within 1 week after surgery in the MPCNL group was significantly higher than that in the FURL group,78.18%(43/55)vs 56.36%(31/55),P<0.05;There was no significant difference in stone clearance rate at 1 month after surgery,(89.09%(49/55)vs 85.45%(47/55),P>0.05;There was no significant difference in the stone clearance rate at 3 months after surgery,(98.18%(54/55)vs 94.54%(52/55),P>0.05.ConclusionAmong the treatment options of upper urinary tract calculi with length and diameter of 2-2.5cm,the advantages of MPCNL were high short-term stone clearance rate and low hospitalization cost.The advantages of FURL include less damage to the body,less severe complications,and faster postoperative recovery.However,one hospitalization was added before the operation to indwelling the ureteral Double-J-catheter,which increased the clinical cost.Therefore,both MPCNL and FURL have good therapeutic effects and safety in the treatment of 2-2.5cm upper urinary calculi,and the specific selection of clinical surgical methods should be combined with the patient's own wishes and the physician's experience. |
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