| Objective:To investigate the safety and efficacy of flexible ureteroscopy combined with extracorporealshock wave lithotripsyfor renal calculi greater than2cm, compared with percutaneousnephrolithotomy.Methods:From november2011to january2013,62patients were diagnosed as solitary renal calculi,which diameter were more than20mm.25cases of patient were peformed with percutaneousnephrostolithotomy,and37patients were peformed with flexible ureteroscopic lithotripsy.And twogroup patiets’ urine and blood samples whose volume were both5ml(4h preoperation,4hpostoperation,24h postoperation,48h postoperation,72h postoperation)were collected, and the renalinjury markers (urine KIM-1,serum NGAL) of two group were detected and compared.Thepatients in flexible utreteroscope group will be treated with extracorporeal shock wave lithotripsy(ESWL) when≥4mm residual stones were found.Than the general efficacy and complications oftwo groups were compared. At last,the efficacy of the two methods of treatment was evaluated bythe results of imaging,and the safty by two renal injury markers and comlication.Results:1.The average operation time of PCNL group was (94.58±34.51) min,and the average timeof hospitalization after operation was (9.72±4.1)days.The overall stone-free rate of PCNL groupwas (18/25) of72%.Meanwhile,the average operation time of FURL group was (92.84±27.95)min,the average postoperative stay was (5.46±1.73) days.And the overall stone-free rate afterthree months was59.46%(22/37).In FURL group,12patients whose residual stones greater than4mm were performed with extracorporeal shock wave lithotripsy,the successful rate of ESWL was(4/12)33.33%.2.The overall incidence of complications of PCNL group was (2/25)8%.And major bleedingduring operation was found in one patient, and he was also found to have fever after operation.Atthe same time,1cases of postoperative fever was found in the other patients.In FURL group,theoverall incidence of complications was (7/37)18.92%.They were consisted of postoperative feverin2cases, postoperative fever with stone street in1case, postoperative fever with urinary infectionin1case, urinary infection with hematosepsis in1case, stone street alone2cases. Comparedoverall complication rate of two groups,there was no significant difference (p>0.05).3.The level of serum NGAL in both PCNL group and FURL group reach the peak at4hoursafter operation.Then it begnan to decline slowly, and decreased to preoperative level until48hours later.After that the level of serum NGA maintained at the preoperative level with no significantchange.At the same time, urine Kim-1in two group both bigan to increase after operation, andreached the peak in24hours.After that the level in two group began to decrease slowly.For patientsin FURL group, the level decrease to the preoperative level in48hours; While patients in PCNLgroup in72hours.4.Compared the serum NGAL and urine Kim-1change after operation of two group, therewas no no statistical difference.Conclusion:Compared with percutaneous nephrolithotomy, FURLcombined with ESEL for kidney stonesgreater than2cm has the same efficacy and complications risk. However, the rate of severecomplications including bleeding in this method is lower than that in the percutaneousnephrolithotomy, while the risk of stone street and fever higher than that of percutaneousnephrolithotomy. The efficacy of FURL combined with ESWL decrease greatly when the stonediameter≥3cm.But it also has the same effect as PCNL.Both two kinds of method have effect inrenal function, but the renal fuction can return to normality in48hours or72hours. And the twokinds of method have no significant difference in renal injury (p>0.05). |
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