| Objective:This research seeks to evaluate the efficacy and safety of flexible ureteroscopy and channel percutaneous nephrolithotripsy in the treatment of kidney stones(1-3cm)and to gain insight into the selection of suitable surgical techniques for clinical use.Research methods:From January 2019 to March 2022,patients with kidney stones with a diameter of 1-3 cm who met the case selection criteria were retrospectively analyzed.One group received transurethral flexible ureteroscopic lithotripsy(64 cases),and the other Percutaneous nephrolithotripsy(60 cases)was used in the FURL group;64 cases in the FURL group,including 36 males and 28 females;age 66.7±8.5 years old,31 cases on the left side and 33 cases on the right side;1cm≤stone diameter 33 cases were<2 cm,31 cases were 2 cm≤stone diameter≤3 cm;19 cases of renal pelvis,11 cases of upper renal calyx,17 cases of middle renal calices,17 cases of lower renal calices,average diameter of stones(1 cm≤average diameter of stones<2 cm)1.512±0.2369cm,average stone diameter(2cm≤stone diameter≤3cm)2.565±0.2627cm;28 cases of mild hydrops,29 cases of moderate hydrops,7 cases of severe hydrops;average CT value of stones 1012.09±189.260Hu,There were 31 cases with waist and abdomen pain,9 cases with hematuria,and 24 cases found in physical examination;and 60 cases in the PCNL group,including 35 males and 25 females,with an average age of 67.3±10.8 years,28 cases on the left side and 32 cases on the right side;1cm≤stone diameter<2cm:32 cases,2cm≤stone diameter≤3cm:28 cases,28 cases of renal pelvis,7 cases of upper renal calyx,8 cases of middle renal calices,17 cases of lower renal calices,the average diameter of stones(1cm≤stones Diameter<2cm)1.613±0.2254cm,average stone diameter(2cm ≤stone diameter ≤3cm)2.586±0.2877cm,36 cases of mild hydrops,21 cases of moderate hydrops,3 cases of severe hydrops,mean CT value of stones 1175.40 ± 175.176 Hu,27 cases with waist and abdomen pain,22 cases with hematuria,and 11 cases found in physical examination.There were no obvious abnormalities in leukocytes and neutrophils in urine routine and blood routine in the two groups before operation;the operation time,postoperative recovery time,hospitalization expenses and postoperative complications of patients in the two groups were analyzed,and the results were compared on the 1 st to 3rd day after operation.1-month stone clearance rate,preoperative and postoperative hemoglobin drop,trauma indicators(CRP and blood WBC)and other information were collected,and according to the type of data,chi-square test and two-sample t-test were used to conduct statistical analysis on the obtained data;Statistical analysis using SPSS20.0 software.Results:The results showed that for kidney stones with 1cm≤stone diameter<2cm,the success rate of lithotripsy and stone-free rate of FURL group reached 93.939%and 96.970%,respectively,while the success rate of PCNL group reached 90.625%and 93.750%.There was no statistically significant difference between them(P>0.05).In addition,for kidney stones with 2cm≤stone diameter≤3cm,the success rate of lithotripsy and stone-free rate in the FURL group reached 87.097%and 93.548%,respectively,while those in the PCNL group reached 90.625%and 96.429%,there was no statistically significant difference in the success rate of lithotripsy and stone-free rate between the two groups.After statistical analysis of the two groups in terms of 1 cm ≤stone diameter ≤3 cm,the operation time,postoperative recovery time and hospitalization expenses of the FURL group were significantly shorter than those of the PCNL group,and there was a statistically significant difference between the two groups(P<0.05);the blood CRP levels of the two groups were 1.060mg/L and 1.431mg/L respectively,statistical analysis showed that there was no statistical difference between the two groups(P>0.05);24 hours after operation,the blood CRP levels of the two groups were Different rises,the average value of the percutaneous nephroscopy group was 21.818mg/L,and the increase was obviously higher than the average value of 11.846mg/L in the flexible ureteroscopy group.Statistical analysis showed that the difference between the two groups was statistically significant(P<0.05);In addition,24 hours after operation,the levels of WBC in the two groups increased to varying degrees,especially the increase in the percutaneous nephroscopic group was significantly higher than the average level of the flexible ureteroscopy group,reaching 14.087 × 109/L,statistical analysis showed that the difference between the two groups was statistically significant(P<0.05),and 24 hours after operation,the hemoglobin content of the two groups of patients decreased slightly,and the reduction value of the FURL group was between between 5.922±0.585g/L,while the PCNL group dropped an average of 19.983± 1.422g/L,and the decline in the PCNL group was higher than the average level of the FURL group,and there was a statistical difference in the effects of the two operations on hemoglobin concentration(P<0.05).After research,we found that the treatment of 2-3cm kidney stones with flexible ureteroscopy is similar to the treatment with PCNL,but the incidence of postoperative bleeding is lower and the recovery is faster.Therefore,FURL can be used as a safe and effective treatment for 2-3 cm kidney stones.Multiple linear regression analysis showed that stone size and operation method were factors that directly affected operation time(P<0.05),explaining 83.80%of the variance.After adjusting R2to 0.413,the postoperative blood HGB concentration of the flexible ureteroscopy group was significantly lower than that of the percutaneous nephroscopy group,and its drop value was 14.061 units lower than that of the percutaneous nephroscopic group,which indicated that the operation method directly affected the postoperative blood HGB concentration Declining factors(P<0.05).Conclusion:Through the analysis,it can be concluded that in the treatment of kidney stones with a diameter of 2.0-2.5 cm and CT<1100 Hu,because FURL has a stoneclearing rate comparable to PCNL,the operation time is also significantly shorter than that of PCNL,and it reduces the postoperative HGB decline and shortens the operation time of patients.It has relatively good advantages in terms of recovery time,reduced cost,and less trauma to the body during surgery.FURL is recommended for the treatment of kidney stones;and when CT≥ 1100Hu,the operation time of PCNL is significantly longer than that of FURL for kidney stones of 2.0-2.5 cm.PCNL is preferred;at the same time,the results of percutaneous nephrolithotomy are significant for kidney stones larger than 2.5cm,no matter if the stone’s CT<1 100Hu or≥1100Hu. |
