Clinical Analysis Of Minimally Invasive Surgery To Deal With Upper Urinary Calculi

BackguroundPCNL(Percutaneous Nephrolithotomy)、URL(Ureteroscopic Lithotripsy) and ESWL(Extracorpoeal Shock Wave Lithotripsy) are recommended as first-line treatment of urinary calculi, which changed the open surgry mode. Ureteroscopic treatment of ureteral stones had become more common with increasingly practical, tolerable, and successful results. In combination with certain auxiliary procedures ureteroscopy lithotripsy become the standard procedure in the management of certain ureteral stones. Advances in endoscopic equipment had expanded the indication range of ureteroscopy lithotripsy, so that not only distal and midureteral stones, but also more proximally located calculi could be successfully managed. The treatment of ureteric calculi with ureteroscopy lithotripsy was by far the most cost effective and expeditious means of clearing ureteral stone burden. Femstrom and Johansson first reported the establishment of a percutaneous tract specifically for stone removal in1976. Since then,further advances in the technique and epuipment have allowed urologists to perform percutaneous stone removal with an increasing success rate and reduced morbidity. Percutaneous nephrolithotomy began to be a routine pocedure in developed in the early1980s and was considered the procedure of choice for the endoscopic treatment of stones, which was also a well-estalished procedure for the treatment of nearly all types of stones in the kidneys. Percutaneous nephrolithotomy has been recognized as generally acceptable for treating renal calculi both in the elderly and in the young. In recent years, percutaneous nephrolithotomy should be the first-line treatment for large or multiple kidney stones. At present, Percutaneous nephrolithotomy and ureteroscopic lithotripsy for urinary calculi has common in China. more and more doctor can master them. But the chirurgic complication could not be avoidble. It is a procedure to master them. This study reported210cases, researching surgery of percutaneous nephrolithotomy and ureteroscopic lithotripsy,and analyzed diagnosis, therapy and operation. It is helpful for clinical practice.Objectives:To summarize the clinical experience and present the clinic efficacy of percutaneous nephrolithotomy(PCNL) and ureteroscopic lithotripsy (URL) in the treatment of calculi. Methods:A retrospective analysis was made on clinical data of208cases,who were hospitalized in the urology of General Hospital affiliated Tianjin medical university during October2007to December2012.155patients with renal calculi or upper ureteral stone underwent PCNL, and53patients with ureteral stone underwent URL. The mean operation time, mean bleeding volume, rate of complication and stone-free rate were recorded and analysed, according clinical problems.Result:Among the155PCNL cases,129cases presented stone free on the first PCNL. The stone clear rate amounted84.5%. The mean operation time was97min(30-300). The mean blood loss was82ml(20-800).26cases had residual stone. The mean hospital stay time was17days. Complication occurred in28cases, Of which,8cases had hemorrhage,5cases had transfusion.,6cases had infection and fever,4cases had double-J tube displacement,2cases had renal perforating injury,2cases had seroperitoneum,1case had pneumothorax.53cases underwent the treatment of ureteroscopic pneumatic ballistic lithotripsy, of which7in the upper,32in the middle, and14in the lower, the single-session success was88.6%,71.4%in the upper segment,87.5%in the middle segment,100%in the lower segment. The mean operation time was90min, the mean hospital stay time was13days.6cases had residual stone. Complication occured in9cases, of which,2cases had ureter perforation,5cases had fever,2cases had double-J tube dispalcement.Conclusions1.Bcterial culture on urine specimens is necessary.2.Oboservational treatment of ureteral calculi pass spontaneously after renal colic can be considered.3.In spite of PCNL and URL are effective procedure in treatment of calculi, Make sure the indication selection of PCNL and URL, and prevent the complication.