Comparison of the effects of ultramicro-channel and micro-channel percutaneous nephroscopy combined with flexible ureteroscopy in the treatment of kidney stones ≥ 2.5 cm in diameter in the oblique supine lithotomy position
Objective To investigate the efficacy of ultra-micro channel percutaneous nephrolithotripsy(PCNL)and micro-channel PCNL combined with ureteroscope in the treatment of renal stones ≥ 2.5 cm in diameter at the inclined supine lithotomy position.Methods Ninety-six patients with kidney stones in our hospital were selected.The patients were divided into an ultramicro-channel group and a micro-channel group according to different operation methods,48 in each group.In the ultramicro-channel group,the ultramicroscopic channel PCNL combined with ureteroscope was used in the oblique supine lithotomy position.In the micro-channel group,the patients were treated with the same position and operation style as the ultramicro-channel group.Urinary CT examination was performed after 3 days of surgery to evaluate the stone clearance rate.The intraoperative time of channel establishment,lithotripsis time,whole operation time and postoperative hospitalization time were recorded.Visual analogue scale(VAS)was used to evaluate the pain degree of the two groups after 24 hours of surgery.The serum indexes before and after surgery as well as postoperative complications were compared between the two groups.Results There was no significant difference in stone clearance between the two groups(P＞0.05).The time of channel establishment and postoperative hospitalization time in the ultramicro-channel group was shorter than that in the micro-channel group,but the time of lithotripsis and total operation time in the ultramicro-channel group were longer than those in the micro-channel group(P＜0.05).The VAS score of the ultramicro-channel group was lower than that of the micro-channel group(P＜0.05).After surgery,the levels of serum creatinine(Scr),C-reactive protein(CRP)and procalcitonin(PCT)were increased and the levels of hemoglobin(Hb)were decreased(P＜0.05).However,there was no statistical difference in these indexes between the two groups(P＞0.05).There was no significant difference in the total incidence of complications between the two groups(P＞0.05).Conclusions The clearance rate of kidney stones ≥ 2.5 cm in diameter with ultramicro-channel and micro-channel PCNL combined with ureteroscopic surgery is similar and safe.The former has shorter channel establishment time,faster post-operative recovery and less pain,while the latter has shorter lithotripsy time and full operation time.
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