Efficacy of ultrasound plus X-ray guided percutaneous nephrostomy on urogenital fistula
Objective To investigate the efficacy and safety of ultrasound combined with X-ray guided percutaneous nephrostomy in patients with urogenital fistula.Methods Seventy patients with urogenital fistula were diagnosed and treated in Henan Cancer Hospital from January 2018 to September 2023.All patients underwent percutaneous nephrostomy,among whom 35 patients received surgery with the guidance of ultrasound plus X-ray(observation group)and the other 35 patients received surgery with the guidance of simulated CT plus X-ray(control group).The surgical success rate,intrasurgical blood loss,radiation exposure dose,X-ray exposure time,surgical time and length of hospital stay were recorded.The levels of serum creatinine and urea nitrogen were compared between two groups before and on day 7 after surgery.The postsurgical recovery was evaluated using the 15-item Quality of Recovery(QoR-15)scale on day 1 and 3 after surgery.Results The surgical success rate was higher in observation group(100.00％)than that in control group(88.57％)(x2=4.242,P=0.039).The patients in observation group had lower intrasurgical blood loss[(3.06±1.12)mL],lower radiation exposure dose[(2.13±0.05)mGy],shorter X-ray exposure time[(3.54±1.23)min],shorter surgical time[(30.21±8.38)min],and shorter hospital stay[(3.14±2.09)d]compared with those in control group[(10.06±1.45)mL,(6.38±1.02)mGy,(9.52±2.73)min,(57.72±10.61)min,(4.52±2.42)d](t=22.550,24.630,11.830,12.041,2.540;all P values＜0.05).The levels of serum creatinine and urea nitrogen were lower in observation group[(125.67±21.58),(214.69±89.23)μmol/L]than those in control group[(237.36±20.45),(321.48±82.40)μmol/L]on day 7 after surgery(t=9.405,P＜0.001;t=7.204,P=0.003),showed no significant differences between observation group[(389.24±19.83),(459.34±106.38)μmol/L]and control group[(375.24±18.63),(468.30±98.45)μmol/L]before surgery(t=1.562,P=0.862;t=1.295,P=0.390),and were lower in both group on day 7 after surgery than those before surgery(t=6.766-53.205,all P values＜0.05).The scores of physical independence,physical comfort,psychological support,pain,and emotional state on the QoR-15 scale were higher in observation group than those in control group on day 1 and 3 after surgery(t=4.396-10.395,all P values＜0.05),and were higher on day 3 after surgery than those on day 1 after surgery in both groups(t=-10.647 to-5.801,all P values＜0.05).Conclusion Percutaneous nephrostomy under the guidance of ultrasound plus X-ray is safe and effective for patients with urogenital fistula,with the advantages as minimal invasiveness,real-time monitoring,high surgical success rate,short X-ray exposure time,low radiation exposure dose and quick recovery after surgery.
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