| Objective: To explore the feasibility,safety and clinical efficacy of F4.8 visual nephroscope in percutaneous nephrolithotomy for the treatment of subrenal calyx stones,and to analyze and compare it with flexible ureteroscopy(f-URS).Methods: From July 2018 to December 2019,86 patients with lower calyceal stones admitted to the second urology department of Gansu Provincial People’s Hospital who met the inclusion criteria of this study were selected.63 cases had low back pain and gross hematuria and 23 cases were found by physical check-up(no obvious symptoms).All were diagnosed as subrenal calyx stones and many of them had different degrees of hydronephrosis through imaging examination.The degree of hydronephrosis was mild in 19 cases,moderate in 5 cases,and 62 patients didn’t have hydronephrosis.All patients had complete urine routine,blood routine,blood biochemistry,urinary culture before operation,31 cases with urinary tract infection,routine urine leukocytes(+)11 cases,(++)17 cases,(+++)3 cases.According to the results of urine culture,all the infected patients were treated with sensitive antibiotics.Until their white blood cells of urine routine examination were negative.Then they were divided into visible nephroscope(VP)group and flexible ureteroscopy(f-URS)group according to different surgical methods.VP group: A total of 40 patients completed the operation,including 22 males and 18 females.The age ranged from 25 to 68 years,with an average age of(47.48 ± 10.52)years.The course of disease was 5 to 13 months,with an average of(8.30 ± 2.14)months.There were 21 cases of left kidney stones and 19 cases of right kidney stones.Stone diameter is 1.3-1.8cm.Percutaneous nephrolithotomy was performed to them with F4.8 visual nephroscope.F-URS group: A total of 46 patients completed the operation,including 26 males and 20 females.The age ranged from 22 to 70 years,with an average of(49.43 ± 11.85)years.The course of disease was 4 to 11 months,with an average of(7.70±1.91)months.There were 24 cases of left kidney stones and 22 cases of right kidney stones.Stone diameter is 1.5-2.0cm.F-URS was performed to them.Both procedures were performed by the same surgeon.Through statistical comparison and analysis of perioperative indicators(hemoglobin decline value,first-stage stone clearance rate,surgical time,urine clearing time,average hospitalization time,postoperative complications,NRS score of the two groups of patients.The 3-4 weeks postoperative follow-up KUB was used to evaluate the rate of clear stone,and the first-stage stone removal rate was counted.Through outpatient appointment or telephone follow-up,the duration is 8-12 weeks.Recording the patient’s relevant imaging indicators,test indicators,complementary therapy and secondary surgery.The clinical efficacy and differences of the two groups of operations were compared by statistical methods.Results: There were 86 patients in the two groups.In the visual nephroscope group,due to the implementation of total tubeless,there were no nephrolithotomy tube and ureteral stent indwelled,so the operation time(48.18± 8.19)min in the VP group was significantly lower than that in the f-URS group(69.96 ± 8.72)min.The average hospital stay of VP group(4.13 ± 0.85)days was longer than that in the f-URS group(5.04 ± 0.97)d,the differences were statistically significant(P <0.05).The rate of successful operation 90.0%(36/40)was better than that of f-URS group of 71.7%(33/46),the difference was statistically significant.The decrease of hemoglobin 7.20(6.73-8.38)g / L was higher than that of f-URS group 4.60(4.10-5.30)g / L,and the difference was statistically significant(P <0.05).As for postoperative complications,4 patients(10%)had delayed bleeding in VP group and 8 cases(17.4%)had ureteral mucosal damage in f-URS group.3 cases(10.7%)in postoperative fever in VP group and 5 cases(10.9%)in the f-URS group.There was no statistically significant difference in urine clearing time of VP group(1.88 ± 0.33)days compared with(1.80 ± 0.59)days in f-URS group(P> 0.05).There was no statistically significant difference in NRS score between the two groups at 24 hours after operation(P> 0.05).Follow-up 3-4 weeks postoperative follow-up KUB was used to evaluate the stone clearance rate.The first-stage stone clearance rate was 95.0%(38/40)in VP group,which was slightly better than 93.5%(43/46)in f-URS group,but the difference was not statistical.There was no significant difference between the two groups requiring extracorporeal shock wave lithotripsy to treat residual stones and patients requiring secondary surgery.Conclusion: F4.8 tubuless percutaneous nephrolithotomy with visual nephroscope is a safe and effective method for the treatment of subrenal calyx stones.Compared with f-URS,it can improve the successful operation rate and has a good first-stage stone clearance rate,avoided ureteral mucosal damage and shorten the operation time and hospital stay.However,there is also a risk of complications such as postoperative fever and delayed bleeding.In summary,F4.8 visual percutaneous tubeless nephrolithotomy is a new technology that provides more surgical options for urologists in the treatment of subrenal calyx stones. |
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