Clinical Analysis Of Percutaneous Nephrolithotomy In The Treatment Of Upper Urinary Calculi

Research objectiveThrough the acquisition of 2017 in February February 2015 in the Department of urology for percutaneous nephrolithotomy cases,safety and efficacy of percutaneous nephronlithotomy in treatment of upper urinary calculi,explore the application of precutaneous nephrolithotomy in clinical practice and the prevention of complications.Research methodThrough the acquisition of 2017 in February 2015 February in the Department of Urology of our hospital for upper urinary tract calculi hospitalized and accepted clinical data of 165 cases of percutaneous nephrolithotomy patients,to evaluate the safety and efficacy of surgery,for the prevention and treatment of complications occurred during and after the operation of the discussion.ResultsThe selected 165 patients were under the guidance of ultrasound percutaneous nephrolithotomy,no deaths,no adjacent organ damage cases,postoperative patients were discharged from hospital,postoperative hospital stay for 6-11 days.15 cases of serious bleeding in cases in which surgery of severe hemorrhage in 11 cases,the intraoperative coagulation and accelerate the speed of perfusion fluid to maintain clear field of operation to complete the first phase of stone surgery;postoperative severe hemorrhage in 4 cases,1 patients underwent conservative treatment for hemostasis,selective renal artery embolization in treatment of 2 another example,1 patients underwent nephrectomy.There were 12 cases of perforation or laceration of the renal collecting system,including 4 cases of renal parenchyma tear,5 cases of renal neck laceration,1 cases of parenchymal tear and calyx neck tear,and 2 cases of renal pelvis perforation.There were 21 cases with high fever after operation.Among them,only 10 cases were treated with nephrostomy,drainage fluid,bacterial culture + drug sensitivity test,and 1 cases with septic shock.They were cured and discharged.In the aspect of stone removal rate,the rate of stone removal was >90% in simple upper ureteral calculi,the rate of stone removal in pure renal pelvis calculi was >90%,and that of multiple renal calculi and staghorn calculi was <60%.All patients with residual stones underwent reoperation or combined with ESWL,and the total stone removal rate was 90%.Research conclusionPercutaneous nephrolithotomy is a safe and effective method for the treatment of upper urinary tract calculi.It is a common complication of bleeding,fever,infection and residual stones.Complications can occur at any stage of puncture,channel expansion,lithotripsy,and after surgery.Although the low incidence of severe bleeding,but often ferocious,in need of emergency treatment,or hemorrhagic shock,and even lead to the risk of death.The perforation and laceration of the renal collecting system are closely related to the experience and operation skills of the patients.The main reason for intraoperative injuries is the desire to seek quick,rough movements and unclear vision.Lavage of postoperative infection,has been in existence before operation in pressure washing,the bacteria,pyrogen and endotoxin in the blood and lymphatic drainage,postoperative poor drainage is the cause of the infection factors,urine bacterial culture and drug sensitive test should be used as routine ultrasonic lithotripsy,suction can effectively control the perfusion pressure,reduce perfusion absorption.The size,location,texture and anatomy of the stone directly affect the removal rate of the operation,while the combination of two stage percutaneous nephrolithotomy and extracorporeal lithotripsy can effectively remove the residual stones and improve the rate of stone removal.The accumulation of clinical experience and the improvement of skill proficiency can effectively reduce or avoid complications.