Comparison Of Therapeutic Effect Of Retrograde Intrarenal Surgery With Holmium Laser And Percutaneous Nephrolithotripsy For 2～3cm Renal Calculi

Objective: To compare the efficacy of retrograde intrarenal surgery with holmium laser and percutaneous nephrolithotripsy for the treatment of 2～3cm renal calculi.Methods: 106 cases of patients with 2～3cm single renal calculi in our hospital from January 2017 to December 2018 were divided into two groups: one group were treated with retrograde intrarenal surgery with holmium laser(RIRS group,52 cases)and the other group were treated with percutaneous nephrolithotripsy(PCNL group,54cases).The operation time,reduced hemoglobin,elevated white blood cell count,postoperative hospital stay time,Stone free rate 2 days and 1 month after operation,pain degrees and complications after operation of the two groups were statistically analyzed.Results: The total operation time of RIRS(65.32±10.1min)was longer than that of PCNL(56.59±11.2min),and the difference was statistically significant(P<0.05).There was no significant difference in operation time between RIRS group and PCNL group in upper calyceal calculi,middle calyceal calculi and renal pelvis calculi(P>0.05).The operative time of calculi in the lower calyx was longer than that in the PCNL group(P<0.05).Postoperative decreased Hb in the RIRS group(3.21±1.0g/L)was significantly lower than that in the PCNL group(14.22±2.1g/L),and postoperative hospitalization time in the RIRS group(2.96±0.6d)was significantly shorter than that in the PCNL group(6.91±1.2d),the difference was statistically significant(P<0.05).There was no significant difference in postoperative WBC elevation between the two groups(P>0.05).The stone free rate of RIRS group two days after surgery was 73.07%,significantly lower than that of PCNL group 90.74%,and the difference was statistically significant(P< 0.05).However,the stone free rates of the two groups were 92.31% and 92.59% respectively one month after surgery,and the difference was not significant,(P>0.05).The postoperative mild pain rate in the RIRS group was 71.15% higher than that in the PCNL group,with a statistically significant difference(P<0.05);the moderate pain rate was 28.85% lower than that in the PCNL group,with a statistically significant difference(P<0.05).However,there was no significant difference in the postoperative painless rate of 0%,severe pain rate of 0% and 3.71% between the two groups(P>0.05).The incidence of postoperative complications in RIRS group was 1.92% significantly lower than that in PCNL group9.26%,and the difference was statistically significant(P<0.05).Conclusion: Both retrograde intrarenal surgery with holmium laser and percutaneous nephrolithotomy are effective for the treatment of 2～3cm single renal calculi.Although the operation time of retrograde intrarenal surgery with holmium laser is longer than that of percutaneous nephrolithotomy,retrograde intrarenal surgery can effectively reduce the amount of intraoperative blood loss,maintain hemoglobin,shorten the postoperative hospital stay,and reduce the the degree of renal function damage and the degree of postoperative pain in patients,reducing the incidence of postoperative complications,retrograde intrarenal surgery can replace part of percutaneous nephrolithotomy treatment of 2.0 ～ 3.0 cm single renal calculi,but in the surgical treatment of renal calculi still need to be based on the patient’s specific situation.