Analysis Of The Curative Effect Of Combined Treatment With Two Mirrors In Complex Kidney Stones And Establishment Of Prediction Model Of Stone Removal

Objective: To explore the clinical application effect of cystoscopy combined with percutaneous nephrolithotripsy holmium laser lithotripsy in complex kidney stones,further analyze the factors affecting the efficiency of surgical lithotripsy by evaluating the efficacy and safety of double-mirror combined lithotripsy,and finally use the obtained data to build a prediction model of lithotripsy.Methods: A cohort study was conducted to collect 74 patients with complex renal calculi admitted to the Department of Urology,the Second Affiliated Hospital of Kunming Medical University from January 2021 to December 2022.Among them,37 patients underwent flexible cystoscopy combined with percutaneous nephrolithotomy,and the other 37 patients underwent percutaneous nephrolithotomy alone.The variables collected included: Height,weight,BMI,past history,etc.The patients in the experimental group were treated with percutaneous nephrolithotomy combined with flexible cystoscope holmium laser lithotripsy,while the patients in the control group were treated with percutaneous nephrolithotomy.If the residual stone was more than 0.6cm after the first stage of lithotripsy,the second operation was performed,and the second operation was combined with flexible cystoscope.SPSS 25.0 software was used to further analyze the obtained data.The measurement data consistent with the Gaussian distribution were represented by mean ± standard deviation(),while those inconsistent with the Gaussian distribution were represented by median(upper quartile-lower quartile)M(Q1-Q3).All count data were expressed as percentage((4)).Chi-square test was used for dichotomous variables,independent sample test was used for continuous variables with Gaussian distribution if both samples were consistent,and non-parametric test of independent samples was used otherwise.Set stones are removed as the dependent variable,independent variable as the variables,first single factor Logistic regression analysis,screening,will have statistical significance(P<0.1)all the variables into the multi-factor Logistic regression analysis diagnosis,prediction model was constructed according to the regression analysis results.Hosmer-Lemeshow goodness of fit test and receiver operating characteristic curve(ROC)were used to verify the differentiation and calibration of the prediction model.Results: All patients completed surgical treatment.In the first stage operation,the S.T.O.N.E.score was 8.0(8.0-9.0)in the experimental group and 8.0(8.0-9.0)in the control group.SHA.LIN score was 11.0(10.0-12.0),and control group score was11.0(10.0-11.0).The CT value of hydronephrosis in the experimental group was2.0(-2.0-4.5)HU,and that in the control group was 5.0(-1.0-8.0)HU.No statistical difference was found in the above baseline data after statistical analysis.In the first stage operation,the operation time of the experimental group was 126.0(101.5-130.0)minutes,the length of hospital stay was 13.0(11.0-14.0)days,the postoperative hemoglobin change was(15.1±7.8)g/L,the incidence of stage II lithotomy was37.8%(14/37).Control group were 120.0(105.0-128.0)minutes,12.0(11.0-13.5)day,(20.7±5.6)g/L and 48.6%(18/37).The results showed that the hemoglobin in the experimental group was less than that in the control group,and the difference was statistically significant(P<0.05).In the second stage of operation,the operation time of the experimental group was 58.5(50.0-98.0)minutes,the hospitalization time was6.0(6.0-8.0)days,the postoperative hemoglobin changes were(11.4±6.1)g/L,the control group were: 62.5(50.0-78.5)min,8.0(6.75-9.25)days,(11.1±3.3)g/L,the experimental group had certain advantages in the length of hospital stay(P< 0.05).Comparison of SFR(stone-free rate)between the two groups: SFR of the experimental group was 63.2%(23/37)5 days after surgery and 97.3%(36/37)1month after surgery.The control group were 51.4%(19/37)and 100%(37/37),two groups of comparison results was statistically difference(P<0.05).Among them,18.0%(9/37)in the experimental group and 14.3%(8/37)in the control group had fever greater than 38.5 degrees Celsius after operation,and all of them were given symptomatic fever reduction after operation.One person in the experimental group formed renal capsule hematoma after lithotripsis,and the reexamination after half a month with the renal leakage tube in place found that it had been absorbed by himself.No patient was admitted to ICU for treatment of renal vascular embolism and clinical transfusion due to hemorrhage.The patients were reexamined on the second day after surgery for plain radiographs and CT examinations in the middle and lower abdomen.If there were any residual stones,they were returned to the hospital 2 weeks later for the second stage of surgery through the original channel or re-puncture.The surgical methods were cystoscopy combined with percutaneous nephrolithotripsia.Reexamination at 1 month showed that residual stones had been removed in all patients except for 1 case with complete antler calculus requiring the third stage of operation.Conclusion: The application of double-mirror combined therapy in patients with complex kidney stones is effective,safe and reliable,without significantly increasing postoperative complications,it can still effectively reduce surgical bleeding,reduce the number of hospitalizations,and improve the stone-clearing rate.It is an effective supplement to single channel percutaneous nephrolithotripsy.It is believed that with the accumulation of surgical experience and continuous improvement of operational skills,it will become one of the important means to treat antler calculus,worthy of further application and promotion.