Application Of Partial Tubeless Means In Modified Percutaneous Nephrolithotomy For The Treatment Of Renal And Upper Ureteral Calculi

Objective : To compare the clinical efficacy of partial tubeless modified percutaneous nephrolithotomy in the treatment of renal and upper ureteral calculi,and to explore the safety and feasibility of partial tubeless nephrolithotomy.Methods: A total of 106 patients with renal and upper ureteral calculi from July 2017 to November 2018 were assessed for eligibility at the First Affiliated Hospital of Fujian Medical University,and 100 cases were selected according to inclusion and exclusion criteria.All cases performed unified modified percutaneous nephrolithotomy.After the end of lithotripsy,the patients were randomly divided into experimental group(tubeless mPCNL)and control group(traditional mPCNL)according to whether the nephrostomy tube was placed or not.Respectively,preoperative demographic indicators and stones characteristics,as well as operation time,hemoglobin(Hb)drop,hematocrit drop,change of creatinine and urea nitrogen,perirenal leakage/hematoma incidence,urinary leakage incidence,stone-free rate,postoperative complications incidence(according to the modified Clavien scale),Visual Analogue Scale(VAS)of pain in postoperative 24 hours and discharging,additional analgesics usage,postoperative activity time,postoperative hospital stay and hospital expenses were compared and statistically analysed of both groupsResults : All cases were finish the operation in one-stage,without transit open surgery,and no perirenal leakage/hematoma cases.There was no significant difference between the two groups in the preoperative demographic features and stones characteristics,no significant difference was found between the two groups for the mean operative time [(28.20 ± 10.89 min)vs(30.08 ± 10.40)min,P=0.380),mean postoperative hemoglobin(Hb)drop [(0.44 ± 0.88)g/dl vs(0.62 ± 0.81)g/dl,P=0.283),mean postoperative hematocrit(HCT)drop [(0.012 ±0.311)vs(0.0201 ±0.267),P=0.168],mean postoperative creatinine decreased [(-3.6 ±8.42)umol/L vs(-5.01 ±8.36)umol/L,P=0.171],mean postoperative urea nitrogen decreased [(2.58± 9.95)mmol/L vs(1.05± 1.01)mmol/L,P=0.626],stone-free rate(90% vs 92%,P=1.000),postoperative complications [(level I 9/50 vs 14/50,P=0.342)/(level II 0/50 vs 1/50,P=1.000)/(level III 0/50 vs 1/50,P=1.000)].The postoperative analgesic additional usage was less in experimental group compared with control group(4/50 vs 14/50,P=0.021).Significant difference was shown in mean 24 h postoperative VAS pain score(3.0± 0.79 point vs 7.4 ±1.02 point,P<0.01),mean VAS pain score at discharge(0.5± 0.48 point vs 2.0±0.77 point,P<0.01),urinary leakage incidence(0 vs 22%,P<0.01),mean recovery time [(3.27 ±0.82)d vs 5.0 ±0.29,d,P<0.01],mean postoperative hospital stay [(4.54 ±1.09)d vs(6.22± 0.86)d,P<0.01] and mean postoperative hospital expenses [(27162.65± 2898.04)yuan vs(32638.47 ±3353.28)yuan,P<0.01].Conclusion:Under the precondition of strict indications,the application of partial tubeless means in the treatment of upper urinary calculi by modified percutaneous nephrolithotomy is safe,effective and feasible,which can reduce the postoperative pain of patients,shorten the time of getting out of bed and hospitalization time,without increasing risk of complications.