| Objectives To explore the scope of application of ureteroscopic lithotripsy and percutaneous nephrolithotomy in the treatment of upper urinary calculi,and to provide a basis for the clinical treatment of upper urinary calculi.Methods Methods a retrospective analysis of 1061 upper urinary calculi hospitalized patients,including 512 cases of flexible ureteroscopy,and 549 cases of percutaneous nephrolithotomy(control group).Two groups according to the stone diameter is divided into <1.5cm,1.5~2CM,2~2.5cm,2.5~3cm,>3cm in different size range,comparing the two kinds of minimally invasive surgery in different range of stone size single operation stone clearance rate(after fourth weeks),postoperative complications,operative time,blood loss,hospitalization days.Results(1)the longest stone diameter <1.5cm,flexible ureteroscope and percutaneous nephrolithotomy single surgical stone clearance rate were 97.94%,99.54%;intraoperative and postoperative complication rate were 3.70% and 10.55% respectively;the operation time was 48.18±9.82(min),71.91±12.34(min);operation blood loss were 4.32±0.68(ml)and 35.23±3.14(ml);hospitalization days were 6.71±3.95(day)and 9.37±5.62(day).There was no significant difference in stone clearance rate between the two groups(P>0.05).The complication rate,operative time,intraoperative blood loss and total hospitalization days were less than those of percutaneous nephroscope.There was a significant difference between them(P<0.05).(2)the stone the longest diameter of 1.5 ~ 2cm,flexible ureteroscope and percutaneous nephrolithotomy single surgical stone clearance rate were 88.70%,91.18%;intraoperative and postoperative complication rate were 5.22% and 11.03% respectively;the operation time was 78.08±10.12(min),81.33±13.21(min);intraoperative blood loss was 3.56±0.77(ml),44.76±2.56(ml);hospitalization days were 6.82±3.81(day)and 9.07±5.88(day).There was no significant difference in stone clearance rate and complication rate between the two operations(P>0.05).Operative time,intraoperative blood loss and total length of hospitalization were significantly less than those of percutaneous nephrolithotomy(P<0.05).(3)the stone the longest diameter of 2 ~ 2.5cm,flexible ureteroscope and percutaneous nephrolithotomy single surgical stone clearance rate were 82.61%,85.56%;intraoperative and postoperative complication rate were 8.70% and 11.11% respectively;the operation time was 96.83±11.18(min),104.16±16.12(min);intraoperative blood loss was 5.83±0.48(ml),48.56 ±4.57(ml);hospitalization days were 6.75±3.52(day)and 10.11±5.44(day).There was no significant difference in stone clearance rate and complication rate between the two operations(P>0.05).Operative time,intraoperative blood loss and total hospitalization days were less than those of percutaneous nephroscope.There was a significant difference between them(P<0.05).(4)the stone the longest diameter of 2.5 ~ 3cm,flexible ureteroscope and percutaneous nephrolithotomy single surgical stone clearance rate were 61.29%,82.69%;intraoperative and postoperative complication rate were 9.68% and 13.46% respectively;the operation time was 116.25±14.21(min),125.75±12.11(min);intraoperative blood loss was 4.61±0.82(ml),52.64±3.12(ml);hospitalization days were 7.28±3.81(day)and 8.88±3.47(day).Single operation stone clearance rate flexible ureteroscopy and percutaneous nephrolithotomy was low,there was significant difference(P<0.05),operative time,blood loss,hospital stay flexible ureteroscopy and percutaneous nephrolithotomy were relatively less,there was significant difference(P<0.05),both intraoperative and postoperative complications no significant difference(P>0.05).(5)the stone diameter greater than or equal to 3cm,flexible ureteroscope and percutaneous nephrolithotomy single surgical stone clearance rate were 8.70%,33.96%;intraoperative and postoperative complication rate were 10.87% and 15.09% respectively;the operation time was 121.53±12.16(min),126.34±9.14(min);blood loss the amount of intraoperative were 5.63±0.52(ml)and 58.87±4.24(ml);hospitalization days were 7.31±3.73(day)and 8.70±3.18(day).Single operation stone clearance rate flexible ureteroscopy and percutaneous nephrolithotomy was low,there was significant difference(P<0.05),operation time,intraoperative blood loss,length of hospital stay flexible ureteroscopy and percutaneous nephrolithotomy were relatively less,there was significant difference(P<0.05),both intraoperative and postoperative complication rate significantly the difference(P>0.05).(6)using a paired Wilcoxon test showed that the flexible ureteroscope group preoperative and postoperative mean creatinine were 84.30(68.58,101.70)umol/L,83.10(68.80,100.40)umol/L;the average creatinine of percutaneous nephrolithotomy group before and after surgery were 84.40(66.40,116.00)umol/L,78.30(65.90,111.60)umol/L.The creatinine of both of them was lower than that before operation,and the difference was significant(P<0.05).Conclusions(1)in the treatment of upper urinary calculi,the two kinds of operation have their respective scope of application,which can be reasonably selected according to the patient's condition and patient's wishes.(2)when the longest diameter of stone was <1.5cm,there was no significant difference in stone clearance rate between the two operations.There were fewer complications,shorter operative time,less blood loss and shorter total hospitalization time.(3)when the longest diameter of stone is from 1.5 to 2cm and 2 to 2.5cm,there is no significant difference in stone clearance rate and complication rate between the two operations.Ureteroscopy has shorter operation time,less blood loss and shorter hospitalization time than percutaneous nephroscope.(4)when the longest diameter of stone is 2.5 to 3cm and >3cm,percutaneous nephrolithotomy has a higher stone clearance rate.There is no significant difference in complications between them.However,there are less blood loss,shorter operative time and shorter hospitalization time during ureteroscopy,which can be chosen according to the patient's condition and will.(5)there was no obvious damage to the renal function of the two kinds of minimally invasive surgery.After the operation,the creatinine decreased and the renal function was improved. |
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