| Objectives:To explore the clinical safety and efficacy of micro channel percutaneous nephrolithotomy(MPCNL)and standard channel percutaneous nephrolithotomy(PCNL)in the treatment of complex renal calculi.Methods:The clinical data of 156 patients with complex renal calculi treated by standard channel percutaneous nephrolithotomy(SPCNL)or micro channel percutaneous nephrolithotomy(MPCNL)from January 2015 to January 2018 in Affiliated Hospital of Hebei University of Engineering were retrospectively analyzed.The patients were divided into observation group(MPCNL)and control group(SPCNL)according to random number table method.There were 78 cases in each group.The SPCNL group included 19 cases of staghorn calculi,32 cases of multiple calculi and 27 cases of single calculi.The MPCNL group included 20 cases of staghorn calculi,32 cases of multiple calculi and 26 cases of single calculi.The differences of operative parameters,stone clearance rate,complication rate and renal function between the two groups were compared.Results:The results showed that there was no difference in general data such as sex,age,course of disease,size,location and type of stones between the two groups.The results were as follows:the operation time in MPCNL group was significantly longer than that in SPCNL group,the intraoperative bleeding volume in MPCNL group was significantly less than that in SPCNL group,the hospitalization time in MPCNL group was significantly lower than that in SPCNL group,the intraoperative irrigation volume in MPCNL group was significantly more than that in SPCNL group,and the average time of getting out of bed in MPCNL group was significantly shorter than that in SPCNL group,the differences of the above indexes between the two groups were statistically significant(P<0.05).The clearance rate of one-stage operation for single renal calculi in SPCNL group and MPCNL group was 92.6%and 92.3%respectively.There was no significant difference in one-stage clearance rate of single renal calculi between the two groups(P>0.05).The clearance rate of multiple renal calculi in SPCNL group was 93.8%and that of multiple renal calculi in MPCNL group was 62%.The clearance rate of multiple kidney stones in SPCNL group was significantly higher than that in MPCNL group(P<0.05).The clearance rate of kidney staghorn stones in SPCNL group was 94.7%,and the clearance rate of kidney staghorn stones in MPCNL group was 60.0%,The clearance rate of kidney staghorn stones in SPCNL group was significantly higher than that in MPCNL group(P<0.05).Comparisons between the two groups were as follows:fever occurred in 2 cases(2.6%),hemorrhage in 2 cases(2.6%),interventional embolism in 1 case(1.3%),blood transfusion in 2 cases(2.6%),peripheral organ injury in 1 case(1.3%)and total complications in 8 cases(10.3%)in SPCNL group;fever occurred in 8 cases(10.3%),hemorrhage in 1 case(1.3%),interventional embolism in 1 case(1.3%),blood transfusion in 1 cases(1.3%),peripheral organ injury in 1 case(1.3%)and total complications in 12 cases(15.4%)in MPCNL group.The fever rate in MPCNL group was significantly higher than that in SPCNL group,indicating that there was a significant difference in the fever rate between the two groups(P<0.05).There was no significant difference in WBC level between the two groups before and after operation(P>0.05);there was no significant difference in CRP level between the two groups before operation(P>0.05);C-reactive protein(CRP)was 18.34±1.99 in SPCNL group after operation,C-reactive protein(CRP)was 10.39±2.90 in MPCNL group after operation,and CRP level in MPCNL group was significantly lower than that in SPCNL group after operation.The difference was statistically significant(P<0.05).The renal function indexes of the two groups were as follows:the BUN level in SPCNL group was 15.22 ± 5.88,It was 10.36±4.12 in MPCNL group,and the BUN level in SPCNL group was significantly higher than that in MPCNL group(P<0.05).The level of serum creatinine(SCR)in SPCNL group was 113.53±11.18 and That was 92.16±49.90 in MPCNL group.The level of SCR in SPCNL group was significantly higher than that in MPCNL group(P<0.05).The VAS scores of the two groups before and after operation were as follows:there was no significant difference in the VAS scores before operation between the two groups(P>0.05);the VAS scores of MPCNL group were significantly lower than those of SPCNL group in one day,two days and three days after operation,indicating that there was significant difference in the VAS scores between the two groups(P<0.05).Conclusions:Micro channel percutaneous nephrolithotomy with holmium laser lithotripsy and standard channel percutaneous nephrolithotripsy with holmium laser lithotripsy are effective treatments for patients with single renal calculi(stone diameter greater than 2.5 cm).However,micro channel percutaneous nephrolithotripsy with holmium laser lithotripsy has the advantages of more minimally invasive,less impact on renal function and higher patient comfort.Therefore,this operation is recommended as the first choice;For patients with multiple kidney stones or staghorn stones,standard channel percutaneous nephrolithotomy with holmium laser lithotripsy has the advantages of high stone clearance rate,fewer complications and less trauma.Therefore,it is recommended as the first choice. |
PDF Full Text Request