Clinical Observation Of Holmium Laser Lithotripsy Combined With Extracorporeal Shock Wave Lithotripsy In The Treatment Of Renal Calculi

Objective:To discuss the safety,efficacy and clinical value of ureteroscopy holmiumlaser lithotripsy combined with extracorporeal shock wave lithotripsy for thetreatment of massive renal calculi.Methods:We retrospectively analyzed the basic data of patients with renal calculitreated by ureteroscopy holmium laser lithotripsy combined with extracorporealshock wave lithotripsy during March 2015 to June 2017,meanwhile,we selectedpatients in the same period with renal calculi treated by percutaneousnephrolithotomy as control.To evaluate the operative time,hemoglobin loss,postoperative hospital stay,number of operations,number of extracorporeallithotripsy,stone clearance rate,preoperative and procalcitonin,C-reactiveprotein,and ipsilateral renal glomerular filtration rate and postoperativecomplications.Results:Compared with the control group,patients in the observation group hadlonger operation time,less hemoglobin loss and shorter postoperative hospitalstay,and the difference between the two groups was statistically significant(p <0.05).The number of operations in the observation group was slightly more thanthat in the control group,the difference was not statistically significant(P>0.05),however in the comparison of the number of extracorporeal lithotripsy,theobservation group was significantly more than the control group,and thedifference was statistically significant(P<0.05).).The stone clearance rate washigher in the observation group than in the control group,the difference betweentwo groups was not statistically significant(P>0.05).Patients with lower calycesof the kidney had a higher stone clearance rate when treated with percutaneousnephrolithotomy,the difference was statistically significant.(P<0.05).While in that treatment of kidney stone patient with ureteroscopy holmium laserlithotripsy,the clearance rate of stones in renal pelvis,suprarenal septum,andmidgut was significantly higher than that in lower jaw,the difference wasstatistically significant.(P<0.05).The incidence of postoperative complicationswas 29.2 % in the observation group and 54.2 % in the control group,thedifference was statistically significant(P<0.05).The levels of procalcitonin and c-reactive protein were increased and glomerular filtration rate was decreased inthe control group one day after operation,the difference was statisticallysignificant(P<0.05).the levels of procalcitonin and c-reactive protein in theobservation group were increased one day after operation,the difference wasstatistically significant(P<0.05),The control group had more significant changesthan the observation group after operation,the difference between the twogroups was statistically significant(p < 0.05).Conclusion:Staged ureteroscopy holmium laser lithotripsy combined withextracorporeal shock wave lithotripsy is safe and effective in the treatment oflarge-load renal calculi,which can be used as a reliable treatment for large-loadrenal calculi.