| Objectives:To compare the clinical effects of Shuotong ureteroscopy and percutaneous nephroscopy in the treatment of upper urinary calculi,analyze the effectiveness and safety of the two surgical methods,and explore the best treatment method for upper urinary calculi,so as to provide theoretical data and methodological reference for the clinical treatment of upper urinary calculi.Methods:A prospective controlled study was conducted on 50 inpatients with upper urinary tract calculi who met the inclusion criteria from February 2017 to March 2019 in the Department of Urology,the Second Affiliated Hospital of Kunming Medical University.Before operation,the patients were fully communicated with each other about the two kinds of operation methods,and the patients were allowed to choose their own operation methods,which were divided into two groups.Among them,25 patients with upper urinary calculi were treated with Shuotong holmium laser lithotripsy(Shuotong group),and 25 patients with upper urinary calculi were treated with percutaneous nephrolithotomy(PCNL group).General anesthesia was used for the operation.The general data,stone size,operation time,preoperative and postoperative hemoglobin(HGB)decrease,preoperative and postoperative white blood cell(WBC)difference,hospitalization expenses,total hospital stay,postoperative hospital stay,postoperative fever rate,stone clearing rate(SFR),complications and other indicators were statistically analyzed to compare the therapeutic effects of the two surgical methods.Results:1.There was no significant difference in stone diameter,sex,age,stone location,creatinine and separation degree of renal aggregation system between the two groups(P>0.05).2.Shuotong group successfully took 23 cases of stone removal,the success rate was 92%(23/25),and 25 patients in PCNL group successfully established channel-parallel lithotripsy.The success rate was 100%(25/25).The difference was not statistically significant(P>0.05).3.The average operation time of the Shuotong group was(62.61±29.34)min,and the average operation time of the PCNL group was(71.00±23.36)min.The average operation time of the PCNL group was longer than that of the Shuotong group.The difference was not statistically significant(P>0.05).4.The average length of hospital stay in the Shuotong group was(2.08±0.79)d,and the average hospital stay in the PCNL group was(5.40±4.36)d.The average hospital stay in the Shuotong group was shorter than that in the PCNL group,and the difference was statistically significant(P<0.05).The total hospital stay in the Shuotong group was(6.22±2.54)d,the total hospital stay in the PCNL group was(11.12±5.77)d,and the total hospital stay in the Shuotong group was shorter than that in the PCNL group,and the difference was statistically significant(P<0.05).The cost of surgery in the Shuotong group(12254.63±3215.51)RMB and the cost of surgery in the PCNL group(18644.22±10463.32)RMB were lower than those in the PCNL group,and the difference was statistically significant(P<0.05).5.There were no significant differences in WBC,HGB,and Cr levels between the two groups before surgery.There were significant differences in WBC and HGB between the two groups(P<0.05).The difference between Cr and preoperative was not statistically significant.The WBC and Cr levels in the Shuotong group were lower than those in the percutaneous nephrolithotomy group(P>0.05),while the HGB level was higher than that in the percutaneous nephrolithotomy group.The difference between the level and the PCNL group was statistically significant(P<0.05).6.The SFR of the Shuotong group was 69.6%(16/23)on the 2nd day after surgery,and the SFR was 96.0%(24/25)on the 2nd day after the PCNL group.The Shuotong group was lower than the PCNL group on the short-term SFR.Statistical difference(P<0.05).The SFR of the Shuotong group was 82.6%(19/23)in January,and the SFR was 96%(24/25)in the PCNL group.The difference was not statistically significant in the long-term SFR(P>0.05).The stone clearing rate of the kidney stone was 62.5%(5/8)and the ureteral stone removal rate was 93.3%(14/15).The rate of clear stone in the PCNL group was 88.9%(8/9)and the clearance rate of ureteral stones was 100%(16/16).The clearance rate of kidney stones and ureteral stones in the PCNL group was comparable,while the clearance rate of ureteral stones in the Shuotong group was higher than that in the kidney stones.7.Comparing the incidence of complications between the two groups,the incidence of complications in Shuotong group was 8.7%,and that in PCNL group was 36.0%.The incidence of complications in Shuotong group was lower than that in PCNL group,the difference was statistically significant(P<0.05).The CDCS was used for grading.In the 23 patients with the Gynecologic group,perioperative period occurred.Complications occurred in 3 patients(13.0%),including 2 patients with grade Ⅰ complications(8.6%),1 patient with grade Ⅱ complications(4.3%),0 patients with grade Ⅲ complications(0.0%),and 0 patients with grade IV complications(0.0%),grade Ⅴ complications(0.0%),including low-grade(Ⅰ～Ⅱ)perioperative complications in 3 cases(13.0%),high-grade(Ⅲ～Ⅴ)complications in 0 cases(0.0%).Among the 25 patients in the PCNL group,9 patients had perioperative complications,including 6 patients with grade Ⅰ complications(24.0%),1 patient with,grade Ⅱcomplications(4.0%),and 2 patients with grade Ⅲ complications(8.0%).Grade IV complications 0 cases(0.0%),grade V complications 0 cases(0.0%),including low-grade(Ⅰ～Ⅱ)perioperative complications in 7 cases(28.0%),high grade(Ⅲ～Ⅴ)complications in 2 cases(8.0%).The incidence of complication in the low grade(Ⅰ～Ⅱ)and high grade(Ⅲ～Ⅴ)of the Shuotong group was lower than that of the PCNL group.Conclusions:1.In the treatment of upper urinary calculi,the Shuotong group and the PCNL group have a lower clear stone rate(SFR)than the PCNL group,and the long-term clear stone rate(SFR)is equivalent.The curative effect is worthy of recognition.2.Holmium laser lithotripsy with Shuotong ureteroscopy is safer than PCNL.It has more advantages in reducing surgical trauma,shortening hospital stay after operation and reducing operation cost.3.Holmium laser lithotripsy with Shuotong ureteroscopyr should be the first choice for patients with ureteral calculi.For patients with<3cm renal pelvis,supracondylar and/or middle calculus,Shuotong holmium laser lithotripsy can partially replace percutaneous nephrolithotomy as a treatment for small-sized kidney stones.4.For patients who are considered to undergo holmium laser lithotripsy under Shuotong ureteroscopy,the size and location of calculi should be carefully assessed before operation,as well as the conditions of ureter,so as to avoid the failure of operation and difficulty of operation caused by difficulty of inserting sheath during operation,and then reduce the stone clearance rate. |
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