Three Minimally Invasive Surgery Through Natural Cavity As Ambulatory Surgery For Treatment Of Upper Urinary Calculi

Background:Ambulatory Surgery is a new management model of surgical diagnosis,treatment and management that has developed rapidly in recent years,which requires that patients’ treatment should be completed within 24 hours,including admission,surgery,and discharge from hospital(in special circumstances,it can be relaxed to 48 hours).At present,the Urology is vigorously carrying out Ambulatory Surgery,and has gradually tried to apply minimally invasive procedures such as rigid ureteroscope lithotripsy,combined rigid endoscope(Shuo Tong ureteroscopy)lithotripsy,and flexible ureteroscope lithotripsy to Ambulatory Surgery mode to treat upper urinary calculi.However,there are certain differences in the effectiveness and safety of these three minimally invasive treatments for upper urinary calculi under the mode of Ambulatory Surgery,and more clinical observations and studies are needed.Objective:This clinical study compares and summarizes the medical expenses,clinical efficacy and safety of rigid ureteroscopy lithotripsy,Shuo Tong ureteroscopy lithotripsy,and flexible ureteroscopy lithotripsy in the treatment of upper urinary calculi under Ambulatory Surgery mode.It will provide a theoretical basis for the promotion and selection of surgical procedures for the treatment of upper urinary calculi by Ambulatory Surgery.Methods: This study is divided into two chapters:Chapter 1 explores the advantages of rigid ureteroscope lithotripsy and Shuo Tong ureteroscopy lithotripsy applied as ambulatory surgery;Chapter 2explores the advantages of flexible ureteroscope lithotripsy applied as ambulatory surgery.Chapter 1 adopts retrospective analysis and research methods,selects patients who have been diagnosed with ureteral calculi in the urology department of Yuebei hospital from July2020 to December 2020 and have undergone ureteroscopic lithotripsy or Shuotong ureteroscopy lithotripsy.90 cases were taken as the research objects,among which: 60 patients underwent Ambulatory Surgery mode(30 patients in the ureteroscope lithotripsy Ambulatory Surgery mode group,30 patients in the Shuo Tong ureteroscoy lithotripsy Ambulatory Surgery mode group),30 patients under the normal operation mode(ordinary ureteroscopic lithotripsy group).There was no statistically significant difference between the three groups in general data such as gender,age,stone longest diameter,stone location,upper urinary tract hydrops,preoperative urine routine,hemoglobin,etc.(P>0.05).Calculate and analyse the preoperative waiting time,total hospitalization time,operation time,total hospitalization cost,blood routine,renal function,procalcitonin changes,stone clearance rate,planned extubation(double J tube)rate,delayed discharge,readmission and surgical complications as the statistical indicator.Chapter 2 adopts retrospective analysis and research methods,selects60 patients who have been diagnosed with kidney stones in the urology department of Yuebei hospital from July 2020 to December 2020 and have undergone ureteroscopic lithotripsy or Shuotong ureteroscopy lithotripsy.60 cases were taken as the research objects,among which:30 patients in the flexible ureteroscope lithotripsy Ambulatory Surgery mode group,30 patients under the ordinary flexible ureteroscope lithotripsy group).There was no statistically significant difference in general information between the two groups of patients before operation(P>0.05),and the relevant evaluation indexes after operation were the same as in chapter 1.The operations of these patients included in the study were all performed by the same experienced senior physician.The data collected in this study were processed by SPSS 22.0 for statistical analysis.Measurement data were expressed as mean±standard deviation((?)±s),and the comparison of means between the two groups was performed by paired t test.Results: Chapter 1: All 90 patients in the three groups were successfully completed the operation,and all patients in the Ambulatory Surgery mode group were discharged from the hospital within48 hours.The preoperative waiting time,total hospitalization time and total hospitalization expenses of patients in the Ambulatory Surgery mode group were significantly less than those in the normal surgery mode group,and the difference was statistically significant(P<0.05).The changes in blood routine,renal function,procalcitonin and operation time of the three groups were basically similar,and the difference was not statistically significant(P>0.05).There was no statistically significant difference in the stone removal rate,planned extubation(double J tube)rate,and surgical complication rate between the three groups(P>0.05).The delayed discharge and re-admission of the three groups of patients were basically similar,and the difference was not statistically significant(P>0.05).The comparison results of a total of 60 patients in Chapter 2 are basically the same as those in Chapter 1.Conclusions:It is a safe,reliable and highly feasible option to perform ureteroscopic lithotripsy、Shuo Tong ureteroscopic lithotripsy and flexible ureteroscope lithotripsy in Ambulatory Surgery mode for the treatment of upper urinary calculi.It can shorten the patient’s preoperative waiting time,hospital stay,reduce hospitalization medical expenses,improve patient satisfaction,and save social medical resources.It is worth promoting and developing in hospitals of various levels.