| Objective:The most key is that piercing to the best calyces with the aid of X-ray or B ultrasound guidance with MPCNL, thereby establishing operational channel that is established properly or not will affect the final stone-free effect. Finally, it can decide the success or failure of the operation. This study attempts to start the most critical place of MPCNL. We collected the X-ray positioning or B ultrasonic positioning group of clinical observation indexes, in order to explore their clinical efficacy, and get a more suitable positioning way for MPCNL. We also make its better used in clinical, and evaluate to treat urinary stones on the efficacy and safety in MPCNL.Methods:From October2010to October2012, we have a retrospective analysis the clinical data of116cases in urological department in the second affiliated hospital of kunming medical university, it had the sugery that was MPCNL due to urinary stones. Randomly selected116cases as the research object,(8patients were lost to follow-up). Line X-ray locating48cases,53cases of B ultrasound localization, collected from X-ray and B ultrasound localization in7cases, we discuss together in here. Separately, on two different positioning methods of preoperative, intraoperative and postoperative clinical objective indicators, and the postoperative follow-up after1month were compared. SPSS17.0statistical software package processed the clinical observation of indicators, measurement data with mean±standard deviation, compared with the t test of two simple dates, count data compared with inspection. We think P<0.05has statistical significanceResults:1. The X ray localization of48cases of aged44.86±12.84, from6to65years old;25cases of male, and23cases of female; The diameter of calculi with1.43±0.70cm;6cases of preoperative hypertension; Calculi with upper calyx in1case, the middle of calyx in23cases, under the calyx in8cases,16cases in the upper ureter; Complete staghorn stones in2cases, partial staghorn stones in2cases, multiple stones26cases, single stones in18cases;43a routine stage lithotomy,3cases have two lithotomy,2cases underwent three periods of take stone, a stone exhausted rate (90%); The average operation time was130.43±31.63min; Intraoperative blood loss80.42±43.75ml; The average hospitalization time6.20±2.08d; Postoperative concurrent infection,9cases, hemorrhage in4cases, without viscera injury; Postoperative1month follow-up, improve water40cases, pain relief32cases, hematuria reduce27cases and calculi recurrence in3cases,2underwent ESWL after calculi recurrence after take all stones,1underwent ureteroscopy take stone. Ultimately,48cases calculi basic exhausted, no case have open lithotomy cases.2. B ultrasound localization in53patients, aged46.36±14.29, from15-76years old, male36, female27cases; The diameter of calculi with1.34±0.62cm; preoperative hypertension in5cases,2cases of diabetes; calculi with upper calyx in2cases, the middle of calyx in24cases, under the calyx in8cases,16cases in the upper ureter, and renal calyx3cases; Complete staghorn stones in1cases, partial staghorn stones in2cases, multiple stones31cases, single stones in19cases;46a routine stage lithotomy,4second stage lithotomy,3underwent three periods of take stone, a stone exhausted rate (83%); The average operation time was102.45±36.32min; Intraoperative blood loss160.07±52.33ml;5.62±2.37d, postoperative hospital stay;16cases of postoperative concurrent infection, of which1case complicated with septic shock and MODS, rescue invalid death, hemorrhage in9cases; Postoperative1month follow-up, the water improvement of43cases,36cases of pain relief, blood in the urine ease30cases,4cases calculi recurrence and calculi recurrence after2routine after ESWL,1underwent ureteroscopy take stone, ancillary platoon stone1case. Ultimately,52cases of calculus basic exhausted, no case have open lithotomy cases.3. X-ray and B ultrasound localization in7cases, aged44.43±7.23, from32to55years old; the male3cases, female4cases; The diameter of calculi with1.43±0.79cm; Preoperative hypertension in1case; Calculi with upper calyx in1case, the middle of calyx in3cases, under the calyx in1case, under the full of kidney in2cases; Complete staghorn stone1case, partial staghorn stone1case, multiple stones in4cases, single stone1case;7cases of total line issue of take stone, a stone exhausted rate of43%; The average operation time was174.29±43.53min; Intraoperative blood loss110.00plus or minus64.55ml; The average hospitalization time6.14±2.00d; Concurrent infection in1case, postoperative bleeding in1case, the merger pleural injury in1case, boc pleural cavity closed type drainage,7d after improving, the postoperative complications are the same patients; Postoperative follow-up in January, the water improvement in7cases,6cases pain relief, blood in the urine (3cases), no stone recurrence cases,6cases of calculus basic exhausted, no case have open lithotomy cases.Conclusion:1. Two different positioning methods of gender, age, control high blood pressure and diabetes of preoperative, stones location, diameter, stones type, not affect the clinical curative effect of MPCNL.2. Used X-ray locating longer than B ultrasound localization in operation time, but, in blood loss of the intraoperative, B ultrasound localization is significantly higher than X-ray in MPCNL.3. Used X-ray locating issue of calculi exhausted rate is higher than B ultrasound localization, and B ultrasonic positioning is higher than X-ray positioning of postoperative infection in MPCNL. To postoperative length of hospital stay, two kinds of positioning methods have no obvious difference, we cannot think which kind of locating way to use can reduce the hospitalization expenses of patients with urinary stones in MPCNL.4. Organ damage also have been happened in MPCNL combined with localization of X-ray and B ultrasound.5. Patients also has certain complications in MPCNL, its clinical applications security still needs further study.6. Two different positioning methods for preoperative symptoms of no significant difference. |
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