Clinical Study Of Percutaneous Nephrolithoscopy Combined With Ureteroscopy For The Treatment Of Complicated Kidney Stones

Objective:To provide a safer and more effective surgical approach for the treatment of complicated kidney stones.In this study,we analyzed and summarized the clinical data of patients with complicated kidney stones treated with dual-scope combination,and initially investigated the effectiveness and safety of percutaneous nephrolithoscopy combined with ureteroscopy in the treatment of complicated kidney stones.Method:The data of patients with complex renal stones treated surgically admitted to the Department of Urology,Huaihe Hospital of Henan University from 01,2020 to 12,2022 were retrospectively analyzed.A total of 18 study subjects were included according to the inclusion and exclusion criteria,including 11 males and 7females;age 33-79 years,average 54.2 years;8 cases of left-sided renal calculi,8 cases of right-sided renal calculi and 2 cases of bilateral renal calculi.There were 3 cases of antler-shaped stones,15 cases of multiple stones,0.7-3 cm in diameter,11 cases of combined urinary tract infection,1 case of preoperative sepsis,and3 cases of combined underlying diseases,such as,hypertension,diabetes mellitus,coronary heart disease and cerebral infarction.The Guy’s score and S.T.O.N.E.scoring system were all used to initially assess the complexity of the kidney stones before surgery.The observation indexes collected included hospitalization cost,postoperative hospitalization time,operation cost,operation time,one-time success rate of percutaneous nephrotomy,intraoperative bleeding,stone removal rate,early postoperative bed time,postoperative extraction time of nephrostomy tube,pre-and postoperative haemoglobin,pre-and postoperative inflammatory indexes and pre-and postoperative renal function indexes,and the occurrence of surgical complications,and SPSS26.0 software was applied to the relevant indexes statistical analysis was performed.All 18 cases were discharged from the hospital after they had undergone the surgery of percutaneous nephrolithoscopy combined with flexible ureteroscopy and met the discharge criteria.Result:1.18 study subjects with combined bimicroscopic surgical treatment were selected.and hospitalized for(16±4)days,including 9(3)days of postoperative hospitalization.The total cost of combined bimicroscopic hospitalization was(30,067.45±6563.13)yuan,of which(6724.88±1231.99)yuan was spent on surgical treatment.The operative time was 127.50(58.75)minutes,including 35(15)minutes for lithotripsy and stone clearing,15(21.25)ml of intraoperative bleeding,2(0.5)days of early postoperative bedtime,and(6 ± 1)days of postoperative nephrostomy tube removal.2.The stone clearance rate of the study subjects was 83.33%.Residual stones in 3 patients,and the patients were asked to take stone expulsion drugs and alpha receptor blockers orally after discharge,and drink more water and exercise.No stones were seen on re-examination after one month,and the residual stones were excreted by medication in all three patients.The first-attempt success rate of percutaneous renal puncture under the guidance of B ultrasound and flexible ureteroscope was 88.89%.Two cases were not successfully punctured at the first attempt.Finally,the percutaneous renal working channels were successfully established.3.All patients successfully completed the combined bimicroscopic lithotripsy without any death due to surgical reasons,no major complications such as pleural,hepatic and splenic and intestinal injuries,and no renal collecting system injuries including urinary extravasation,ureteral avulsion and ureteral stricture.Urinary tract infection with hypothermia was present in only three patients,and all three patients had a preoperative diagnosis of urinary tract infection.One of the patients was diagnosed with sepsis preoperatively and was stabilized by aggressive anti-infection and anti-shock treatment and completed surgical lithotripsy treatment.4.The differences in hemoglobin,leukocytes,neutrophils,and C-reactive protein before and after surgery were not statistically significant(p>0.05);the differences in creatinine levels before and after surgery were statistically significant(p<0.05).Conclusion:1.Percutaneous nephrolithoscopy combined with ureteroscopy has a high rate of stone removal and successful primary puncture rate in the treatment of complicated kidney stones,which can reduce the frequency of secondary surgery,so the combined efficacy of the two scopes is definite;2.The combined bimicroscopic treatment of complex kidney stones does not increase the risk of complications,and there is no significant change in inflammatory indexes before and after the procedure,and the combined bimicroscopic approach is highly safe.