Study On The Efficacy And Safety Of Mini-PCNL Combined With Micro-PCNL In The Treatment Of Complex Renal Calculi

Objective: To evaluate the therapeutic effects and safety of Mini-PCNL combined with Micro-PCNL multi-channel first-stage treatment for complex renal calculi.Methods: The clinical data of patients with complex renal calculi treated by one-stage operation in the Department of Urology of Suining Central Hospital from June 2020 to November 2021 were analyzed retrospectively.According to the inclusion and exclusion criteria,a total of 68 patients were included in the comparative study.According to the different surgical methods,the patients treated with Mini-PCNL combined with MicroPCNL were included in the combination group(n=32),and the patients treated with single channel Mini-PCNL were included in the control group(n=36).The stone clearance rate,postoperative complications and renal function changes were compared between the two groups,and the intraoperative puncture time,operation time and postoperative hospital stay were compared and analyzed.Results: There was no significant difference in preoperative general data between the two groups(P > 0.05).The median diameter of stones in the combined group and the control group was 26.25(24.39 ～ 36.86)"vs27.30(24.94 ～ 31.23)".There was no significant difference in preoperative stone characteristics(stone size,stone density,stone location distribution,stone type,degree of hydronephrosis),preoperative hemoglobin and creatinine between the two groups.There was significant difference in main passage puncture time(12.00minvs14.00min)between the combined group and the control group.There was no significant difference in operation time between the combined group and the control group(P > 0.05).Three months after operation,the stone clearance rate of the combined group was 87.50%,while that of the control group was 66.7%.The stone clearance rate of the combined group was significantly higher than that of the control group(P < 0.05).There was no significant difference in the decrease of hemoglobin and creatinine between the combined group and the control group(P > 0.05).However,the hemoglobin decreased less and the renal function changed less in the combined group.There was no significant difference in postoperative infection rate and postoperative pain score between the combined group and the control group(P > 0.05).The postoperative complications were statistically analyzed by modified Clavien classification,grade I complications(28.13% vs 30.56%),grade II complications(43.75% vs 41.67%),grade Ⅲ a complications in 2 cases(6.25% vs5.56%),no complications above grade Ⅲ b in the combined group,1 case in grade Ⅲ b in the control group(2.87%),and no complications above grade IV.There was no significant difference in the overall incidence of postoperative complications between the two groups(P > 0.05).The postoperative hospital stay in the combined group was similar to that in the control group(P > 0.05).Conclusion: Compared with Mini-PCNL,Mnini-PCNL combined with Micro-PCNL has higher stone-free rate and similar postoperative complication rate in one-stage multichannel treatment of complex stones,with better surgical outcomes and reliable safety.