Comparison Of The Effect Of Microchannel Percutaneous Nephrolithotomy And Flexible Ureteroscope Lithotripsy On Upper Urinary Calculi

Objective:Based on a retrospective analysis of the comparison of the efficacy of microchannel percutaneous nephrolithotomy(MPCNL)and flexible ureteroscope lithotripsy(FURL)for the treatment of stones in the upper urinary tract(diameter between1cm to 2cm,single shot),the safety and effectiveness of the two surgical methods were analyzed.The choice of surgical method for upper urinary calculi in clinical work provides a better solution.Methods:Patients with upper urinary calculi who were treated in the urology department of Hospital from August 2016 to August 2019 were selected.Two surgical methods,microchannel percutaneous nephrolithotomy(MPCNL)and flexible ureteroscope lithotripsy(FURL)were compared to observe the operation time,postoperative hemoglobin decrease,postoperative complications,postoperative length of stay and period I stone clearance rate.All data were statistically analyzed using SPSS 20.0 software.Measurement data are expressed as mean±standard deviation(x±s),and count data are expressed as composition ratio.Two-sample t test was used for comparison between measurement data groups,and?~2 test was used for comparison between count data groups.The difference was statistically significant with P<0.05.Results:The surgery was completed in both groups.The data of gender,age,body mass index and maximum stone diameter were compared between the two groups,P values are equal to 0.236,0.842,0.139,0.219,and the difference was not statistically significant(P>0.05).Among the postoperative observation indicators,the operation time of the FURL group was longer than that of the MPCNL group,t=-5.079,P=0.000,the difference was statistically significant(P<0.05);The decrease of postoperative hemoglobin in the FURL group was less than the MPCNL group,t=4.835,P=0.000,and the difference was statistically significant(P<0.05).Comparison of the postoperative complications between the two groups of patients,The incidence of postoperative complications in the MPCNL group was 8.7%(7 cases)and the incidence of postoperative complications in the FURL group was7.5%(6 cases),?~2=0.084,P=0.772,the difference was not statistically significant(P>0.05);the postoperative hospital stay in the FURL group was lower than MPCNL group,t=8.551,P=0.000,the difference was statistically significant(P<0.05).The period I stone clearance rate of the MPCNL group was 93.7%,and the period I stone clearance rate of the FURL group was 80%,?~2=6.632,P=0.114,the difference was statistically significant(P<0.05).Conclusion:For upper urinary calculi with a diameter of 1 to 2 cm,there was no significant difference in the overall period I stone clearance rate between the MPCNL group and the FURL group;the MPCNL group used an oblique supine lithotomy position,which was easier for patients to tolerate than other positions such as the prone position.16F microchannel renal tissue damage is reduced,and the risk of bleeding is reduced.During the operation,complicated stones or MPCNL stones that are difficult to handle due to the small angle can be treated with dual-mirror combined therapy to obtain the effect of period I stone clearance rate.The fistula was made,and the postoperative hospital stay was prolonged.The FURL group tended to be more minimally invasive.It is difficult for hard stones and lithotripsy,and the operation time is relatively long,so the risk of infection increases.Before the operation,a more appropriate surgical method should be selected according to the actual situation of the patient’s wishes and stone load.