Analysis Of Efficacy And Residual Stones Factors Of Single-session Standard-tract PCNL For Calculus In Upper Urinary Tract

Objective: To study the safety and feasibility of Standard-tract percutaneous nephrolithotomy with ultrasonic and Pneumatic lithotripsy under the guide of Bmode ultrasound for calculus in upper urinary tract. Analysis the influence factors of Preoperative and intraoperative associated with the stone-free rate after PCNL, Provide the reference for improving the stone-free rate of PCNL.Methods: Retrospective analysis of the clinical dates of 81 cases of calculus in upper urinary treated by single-session Standard-tract PCNL under the guide of B-mode ultrasound from July 2015 to March in Tianjin medical university general hospital, 49 cases were male,female 32 cases, with an average age of(55.28±11.44)years.a total of 81 sides calculus in upper urinary,37 cases of left and 44 cases of right. All the stones were positive stones, stone size of the patient which is the longest diameter. Patients with hydronephrosis by B-ultrasound of which 40 cases of hydronephrosis mild or no, moderate hydronephrosis 25 cases,19 cases of severe hydronephrosis.34 cases had the treatment history of ESWL or PCNL or open surgery Preoperative.The low back pain or discomfort patients accounted for 50 cases, 8 cases of hematuria, 20 cases of fever. The classification stones, Upper ureteral calculi in 10 cases,pelvic calculi in 10 cases,kidney with upper ureteral calculi in 20 cases, 25 cases of multiple renal calculi.staghorn calculi in 16 cases. Analysis of efficacy of Standard-tract percutaneous nephrolithotomy in treatment of various types of urinary tract stones, comparison of various types of stone stone-free rate of postoperative.All cases were identified by CT,KUB and IVU, treatment success was defiend as KUB complete clearance of kidney and ureter walking area not found high density shadow stone, B-mode ultrasound no strong echo group with acoustic shadow. According to the presence or absence of residual stones after PCNL, into stone residual group and no residual stone group. Comparison of information Preoperative and intraoperative, age, sex, type of stone, stone size, stone location, degree of hydronephrosis, renal dysfunction, urinary tract infection, stones treatment history, clinical symptoms, calyx puncture position, the operation time, the amount of bleeding and other factors to analysis influence factors associated with the stone-free rate. These factors were analyzed by multivariate Logistic regression analysis, obtain the independent factors that affect the stone-free rate after PCNL.Result: The surgery were completed successfully in all cases,the average calculi dealing were(16.16±10.96)min. the average amount of blood loss were(39.26±37.60)ml, the average hospitalization stay(8.42±2.62)days,The average stone-free rate after operation was 66.67%.No severe hemorrhage, 5 cases had transfusion after the PCNL and 2~8U.One cases of renal calyceal laceration, delayed bleeding or active bleeding 16 cases, 9 cases of fever. Stone-free rate of Upper ureteral calculi was 100%, stone-free rate of pelvic calculi was 100%, stone-free rate of kidney with upper ureteral calculi was 70%, stone-free rate of multiple renal calculi was 48%, stone-free rate of staghorn calculi was 50%. The statistical analysis of five different types of stones confirmed that stone-free rate and blood loss had statistical significance. Use of t-test and χ2 test analysis: type of stone, stone size, stone location, degree of hydronephrosis, renal function, urinary tract infection, Channels, calyx puncture time, calculi dealing time, the amount of bleeding in PCNL postoperative stone-free rate have significant correlation. Multivariate Logistic regression analysis: type of stone, stone location, degree of hydronephrosis, renal dysfunction were independent factors that affect the stone-free rate after PCNL.Conclusions: 1.Single-session Standard-tract percutaneous nephrolithotomy with ultrasonic and Pneumatic lithotripsy under the guide of B-mode ultrasound for calculus in upper urinary tract was safety and feasibility. 2. Type of stone, stone size, stone location, degree of hydronephrosis, renal dysfunction, urinary tract infection, Channels, calyx puncture time, calculi dealing time, the amount of bleeding were the influence factors of stone-free rate of PCNL. 3、Type of stone, stone location, degree of hydronephrosis, renal dysfunction were independent factors that affect the stone-free rate after PCNL.