Effect Analysis Of Super-mini Percutaneous Nephrolithotomy With Flexible Ureteroscopic Lithotripsy In The Treatment Of≦2cm Lower Calyceal Calculi

BackgroundThe incidence of lower calyceal calculi accounts for about 30% of the total renal calculi,which is a common and frequently-occurring disease.The epidemiological characteristics in the world are that the ratio of male to female is 3: 1,and they all occur in20 ～ 50 years old.Lower calyceal calculi can be treated conservatively without symptoms,but patients with lower calyceal calculi with surgical indications can cause renal colic,hematuria,infection,and hydronephrosis and renal failure in severe cases,so the treatment of lower calyceal calculi is particularly important.The treatment of the calculus of the inferior calyx is affected because of the special anatomical structure of the inferior calyx,the Infundibulopelvic Angle(IPA),the number of small calyx,the length of the neck of the calyx,the width of the neck of the calyx and so on.There is still no uniform standard for minimally invasive treatment of lower calyceal calculi,the most prominent of which is the lower calyceal calculi of ≤ 2 cm.It has always been the focus of research and discussion to choose which surgical method is the best.PurposeTo compare the safety and efficacy of three groups of Super-Mini-PCNL(SMP),Flexibl-Ureteroscope-Lithotripsy(FURL),Super-Mini-PCNLand Flexibl-Ureteroscope-Lith otripsy(SMP + FURL)in lower calyx calculi(diameter ≦ 2cm).To explore the curative effect of three surgical methods on the lower calyceal calculi of ≤ 2 cm;To provide reference for the treatment of lower calyx stones.Methods99 patients with lower calyceal calculi of ≤ 2 cm in our hospital from January 2017 to June 2021 were analyzed retrospectively,all of which met the inclusion and exclusion criteria.They were divided into SMP group,FURL group and SMP + FURL group according to different surgical methods,with 33 cases in each group.Stonefreerate(SFR)(%),operative time(min),blood loss(ml),mean postoperative hospital stay and postoperative complications of the three groups were analyzed and compared.Result99 patients were included in the study,including SMP group 33 cases,FURL group33 cases,SMP + FURL group 33 cases.The statistical results of SFR(%),operative time(min),intraoperative blood loss(ml),mean postoperative hospitalization days and postoperative complications were compared among the three groups on the second day and one month after operation as follows:1.The SFR of SMP Group was 90.9%,97.9%,FURL Group was 84.8%,90.9%,SMP + FURL Group was 100%,100%,SMP + FURL Group was higher than SMP Group and FURL Group,but the difference was not statistically significant(P > 0.05).2.The operation time(min)was(54.00±14.00)min in SMP group,(68.00±13.00)min in FURL group and(51.00±21.00)min in SMP + FURL group.The difference was statistically significant(P < 0.05).3.The intraoperative blood loss(ml)was(52.30±8.80)ml in SMP group,(29.60±7.80)ml in FURL group and(52.50±10.80)ml in SMP + FURL group.The difference in FURL group was statistically significant compared with SMP and SMP + FURL groups(P< 0.05).4.The average postoperative hospital stay was(4.00±1.00)days in SMP Group,(4.00±0.00)days in FURL Group and(3.00±1.00)days in SMP Group and FURL Group.The difference was statistically significant(P < 0.05).5.Statistical results of postoperative complications: In SMP group,4 patients had high fever(temperature > 39.0℃),1 case had delayed bleeding after operation,3 patients had high fever(temperature > 39.0 ℃)in FURL group,3 patients had high fever(temperature > 39.0℃)and 1 case had delayed bleeding after operation in SMP + FURL group.The postoperative complications of SMP Group,FURL Group and SMP + FURL Group accounted for 15.2%,9.1% and 12.1% respectively,and there was no significant difference among the three groups(P > 0.05);There were no serious infection,ureteral tear,organ injury,urine extravasation and other complications in the three groups.Three groups of patients with fever were discharged after active anti-infection symptomatic treatment,and three groups of patients with delayed bleeding after operation were discharged after bed rest,pressurized perirenal hemostasis and drug hemostasis.Conclusions1.SMP,FURL,SMP + FURL are safe and effective surgical methods for treatment of lower calyceal calculi of ≤ 2 cm.2.For lower calyceal calculi(≤ 2 cm),SMP + FURL is more effective than SMP or FURL alone.SMP + FURL has the advantages of short operation time,which shortens the hospitalization time of patients,realizes complete tube-free,improves the prognosis of patients,and has certain popularization value.