| Objective To investigate the safety and efficacy of flexible ureteroscope and minimallyinvasive percutaneous nephrolithotomy through the comparative studies in treating upperureteral calculi, thus provide effective help to select the suitable operation mode of upperureteral calculi.Method60patients with upper ureteral calculi were selected as the object of study fromHebei University Affiliated Hospital between December,2012and November,2013. Accordingto the order of admission, the patients were divided into odd groups and even groups.Oddgroups were treated with flexible ureteroscope holmium laser lithotripsy and even groupswere treated with minimally percutaneous nephrolithotomy holmium laser lithotripsy. Therewere38males and22females in the60enrolled patients. They were between30and65yearsold.28patients had rightly upper ureteral calculi patients, and32patients had leftly upperureteral calculi. The average diameter of calculi was1.50±0.25(0.9~2)cm. The course wasabout2to18months. And they were associated with mild hydronephrosis. Hospital routineurine and blood was normal.There are18males and12females in flexible ureteroscope group. They were between30and62years old, and the average age was48years old.13patients had rightly upperureteral calculi, and17patients had leftly upper ureteral calculi. The average diameter ofcalculi was1.51±0.26(0.9～2.0)cm. There were20males and10females in minimallyinvasive percutaneous nephrolithotomy group. They was between32and65years old, and theaverage age was46years old.15patients had rightly upper ureteral calculi, and15patientshad leftly upper ureteral calculi. The average diameter of calculi was1.49±0.24(0.9~2) cm.Intraoperative bleeding volumes, postoperative hospitalization, the stone clearancerate, comfort, pain and trauma index (CRP, IL-6and WBC) of two groups were selected andcompared. X2test and t test were selected according to the data types. When P<0.05, ithad statistical significance. All analyses were performed by the software SPSS16.Result In comparion of flexible ureteroscope group and the percutaneousnephrolithotomy group， the average operation time was86.50±12.81(min) for flexibleureteroscope, and81.83±12.76(min) for Micro channel percutaneous nephrolithotomy, Therewas no significant difference (P>0.05). The average amount of bleeding was2.20±0.58(ml) for flexible ureteroscope, and12.53±2.12(ml) for minimally invasive percutaneousnephrolithotomy. The postoperatively average hospitalization time was3.33±0.61(d) forflexible ureteroscope, and5.47±0.73(d) for minimally invasive percutaneous nephrolithotomy.The hospitalization time and the amount of bleeding of flexible ureteroscope group wassignificantly lower than that of minimally invasive percutaneous nephrolithotomy, and thedifference had statistical significance (P<0.01). The first stage of operation of two groupswere successful, and nobody failen in puncturing and setting flexible ureteroscope. After oneweek of operation, double J tube placement were observed through KUB, and two groupswere normal. Flexible ureteroscope group had23.33%(7/30) residual stone, and minimallyinvasive percutaneous nephrolithotomy had20.00%(6/30) residual stones. Both were treatedby ESWL. After1months of operation, stone clearance rate were90%(27/30) in flexibleureteroscope group, and96.70%(29/30) in minimally invasive percutaneous nephrolithotomygroup. After3months, stone clearance rate was100%(30/30) in flexible ureteroscope group,and100%(30/30) in minimally invasive percutaneous nephrolithotomy group. There was nostatistical significance (P＞0.05). By means of the questionnaire conducted between twogroups of patients, at4,12,24and48h BCS comfort scores of postoperative were2.53±0.51,2.93±0.58,3.47±0.51,3.77±0.43in flexible ureteroscope group, and were obviouslyhigher than those in minimally invasive percutaneous nephrolithotomy group (P <0.01), inwhich they were1.27±0.78,1.63±0.57,2.67±0.58,2.90±0.61. At4,12,24and48h, painpoints though visual analog scale (VAS) were4.03±1.03,2.77±0.86,1.40±0.77,0.83±0.65inflexible ureteroscope group, and were lower than6.90±1.49,5.50±1.20,3.63±1.16,2.37±0.93(P<0.01) in minimally invasive percutaneous nephrolithotomy group. There was statisticalsignificance (P<0.01). Preoperative CRP level of the two groups were5.13mg/L,5.09mg/L.There was no statistical significance (P＞0.05), while the CRP levels in two groups ofpostoperative24hours significantly rised to some extent,and especially minimally invasivepercutaneous nephrolithotomy group (20.42mg/L), were higher than the flexibleureteroscope group (10.91mg/L). Two surgical effects had statistical significance on bloodCRP (P<0.05). Preoperative IL-6levels of two groups were6.42ng/L and6.58ng/Lrespectively. There was no statistical significance (P＞0.05). IL-6levels in postoperative24hours of two groups rised, in particular minimally invasive percutaneous nephrolithotomygroup (15.56ng/L), were far higher than the flexible ureteroscope group (average10.74ng/L).Two surgical effects had statistical significance on blood IL-6(P<0.05). Preoperative blood WBC of the two groups were respectively6.3×109/L and6.39×109/L,and there was nostatistical significance (P＞0.05). While blood WBC of both groups at24h after operationincreased within the normal range, and were respectively7.49×109/L,7.4×109/L. Blood WBCof only2patients in flexible ureteroscope group were beyond the normal range, and there wasno statistical significance (P＞0.05).Conclusion The flexible ureteroscope lithotripsy was more simple, more safe, lesstrauma and more curative effect than minimally invasive percutaneous nephrolithotomy intreating ureteral calculi. It could be a better alternative surgical method and be desirable to befurther popularized for treatment of upper ureteral calculi. |
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