Study On The Minimally Invasive Treatment Of Renal Calyx Diverticulum Stones

Section 1:Meta-analysis of the effectiveness and safety of PCNL versus FURL in the treatment of renal calyx diverticulum stonesObjectiveThe clinical efficacy of percutaneous nephrolithotomy and ureteral chondrolithotomy in the treatment of renal calyx diverticulum stones is still controversial,and the method of Meta-analysis was used to investigate and compare the clinical efficacy of the two procedures.MethodsComparative studies on percutaneous nephrolithotomy and ureteral chondrolithotomy in the treatment of renal calyx diverticulum stones were searched through Chinese and English databases such as China Knowledge Network,MEDLINE,Pub Med,Web of Science,EMBASE,and Cochrane Library until December 2022.All data were analyzed using STATA 15.1 software.The quality of the included literature was evaluated using the Newcastle-Ottawa scale(0-9 stars).Results.Eleven eligible high-quality studies including 486 patients were finally included.Meta-analysis results showed higher stone clearance [OR=3.55,95%CI: 2.07-6.10,p= 0.000] and symptom relief [OR=3.56,95%CI: 1.51-8.38,p= 0.004] in the percutaneous nephroscopy group,while in bleeding [SMD=1.27,95% CI:(0.67,1.87),p=0.000],length of hospital stay [SMD=2.86,95% CI: 1.75-3.97,p=0.000] and complication rate [OR=1.92,95% CI: 1.10-3.33,p=0.021] were inferior to those in the ureteral flexible scopy group,and the two groups had There was no significant difference between the two groups in terms of operative time [SMD=-0.011,95% CI:(-0.41,0.39),P=0.957].ConclusionPercutaneous nephrolithoscopy is significantly better than the ureteral flexible group in terms of the main index of stone removal and symptom relief,but has a slightly poorer safety profile and can be considered as the preferred surgical approach for the clinical treatment of renal calyx diverticulum stones.Section 2:Analysis of the efficacy of PCNL combined with diverticulum neck tomy and diverticulum mucosal burning for diverticulum calculiObjectiveTo investigate the effectiveness and safety of percutaneous nephrolithotomy combined with calyceal neck dissection and diverticular mucosal cautery for the treatment of diverticular calculi in the renal calyces.MethodsWe retrospectively analyzed the clinical data of 19 patients with diverticular stones in the renal calyces admitted to our hospital from September 2019 to December 2021,of whom 10 were male and 9 were female;age ranged from 24 to 62 years,with an average of(46.11±10.32)years;stone size ranged from 0.9 to 2.3 cm,with an average of(1.49±0.42)cm;11 cases were located in the upper calyces,5 cases were located in the middle calyces,and 3 cases In 10 cases,the diverticular stones were located in the left kidney and in 9 cases in the right kidney;12 patients had single stones in the diverticulum and 7 patients had multiple stones in the diverticulum.All patients were treated with holmium laser lithotripsy after ultrasound-guided puncture of the diverticulum of the renal calyces where the stones were located,and holmium laser was used to incise the neck of the diverticulum and cauterize the mucosa of the diverticulum with a ball-shaped electrode.ResultsAll patients completed the surgery successfully in one stage with single channel,and the operation time ranged from 55 to 105 min,with an average of(78.16±14.06)min,and the intraoperative blood loss ranged from 40 to 210 ml,with an average of(80.00±41.77)ml.The success rate of lithotripsy was 100%(19/19).No recurrence of stones was seen in the IVU or CT at 3-12 months postoperatively,and the diverticulum closure disappeared in 18 patients and shrank significantly in 1 patient compared with the previous one,with a diverticulum closure rate of 94.74%(18/19).ConclusionPercutaneous nephrolithoscopy in the treatment of renal calyx diverticulum stones,combined with incision of the calyx neck and cauterization of the diverticular mucosa,is conducive to promoting the closure of the renal calyx diverticulum,effectively reducing the recurrence of stones after surgery,with precise efficacy,safety and reliability,and little trauma,and is worthy of clinical promotion.