Comparison of retrograde catheterization combined with 200 μm laser fiber URL and PCNL in the treatment of upper ureteral calculi
Objective To compare the clinical efficacy of retrograde catheterization combined with 200 μm laser fiber for ureteroscopic lithotripsis(URL)and percutaneous nephrolithotomy(PC-NL)in the treatment of upper ureteral calculi.Methods A retrospective analysis was performed on 180 patients with upper ureteral calculi admitted to our hospital from July 2020 to January 2022.The calculi were located between the upper margin of the sacroiliac joint and the transverse process level of the lumbar 4(L4)vertebra,with a diameter of 1.0-2.0 cm.All patients were divided into two groups by surgical methods.Among the all patients,81 patients were treated with F6.0/7.5 ureteroscopy with 3F ureteral catheter lithotripsis(URL group),and 99 patients were treated with F18 channel PCNL(PCNL group).Preoperative general data of two groups were recorded.Operative time,intraoperative visual field satisfaction,stone clearance rate,renal pelvis pressure after obstruction relief,periopera-tive sepsis incidence,length of hospital stay and total hospitalization cost were recorded in two groups.Hemoglobin and creatinine indexes were recorded before and after operation in two groups.Three months after ureteral stent removal,the intraoperative hydronephrosis was followed up.Results There was no statistical difference in preoperative general data between the two groups(P＞0.05).Opera-tion time[(52.14±15.67)min vs.(38.59±9.34)min,P=0.018]and hospital stay[(8.65± 2.21)d vs.(4.14±1.04)d,P=0.003]were longer in PCNL group than in URL group,and the difference was statistically significant.There were no significant differences in surgical field satisfaction and stone clearance rate between the two groups(P=0.672,0.232).Compared with the URL group,the PCNL group had higher immediate pressure(P=0.043)and higher incidence of postoperative sepsis(P=0.004),with statistically significant differences.Total hospitalization cost in PCNL group was significantly higher than that in URL group(P=0.032).There was no significant differencein he-moglobin(P=0.376,0.385)and creatinine(P=0.486,0.347)between the two groups before and after surgery.The incidence of ureteral stricture in PCNL group was higher than that of URL group(P=0.013).Conclusions Retrograde catheterization combined with 200 μm laser fiber URL and F18 PCNL are both safe and effective in the treatment of ureteral calculi with a diameter of 1.0-2.0 cm from the upper margin of the sacroiliac jointto the transverse process of L4.Compared with F18 PCNL,F6.0/7.5 ureteroscopic 3F ureteral catheter URL has the characteristic of shorter operation time,eco-nomic applicability and less trauma,and is worthy of clinical application.
NETL
NSTL
万方数据
维普
