The Outcomes Of Percutaneous Nephrolithotomy Contrast To Ureteroscopy In The Treatment Of Upper Calculi (with Of 150 Cases)

The outcomes of percutaneous nephrolithotomy contrast to uret-eroscopy in the treatment of upper ureter calculi (with of 150 cases)Objective:To investigating the outcomes of percutaneous nephr olithotomy contrast to ureteroscopy in the treatment of upper ureter calculi.Methods:We retrospectively reviewed the therapy of 150 patients who underwent minimally invasive therapy for upper ureter calculi from 2008.9th to 2010.12th at the Urology Surgery China-Japan Union Hospital of Jilin University, percutaneous nephrolithotomy in 85 patients,ureteroscopy in 65 patients. Before the operatoin,all the patient took the examination of KUB+IVP,TVCDS,Electrocardiogram,Chest X-ray and Blood biochemistry including blood routine examination,urinary routine examination,cogulation time,immunologic test and so on,observed the body tempreture and urine volume,preventability used two or three days antibiotics.If the patient who was infection and got a fever again and again,we actively gave the anti-infective or percutaneous nephrocentesis.Entirety evaluate the patient could tolerate the operation or not,then we confessed the patient conditions and surgical methods.If the patient refused the PCNL or the body condition was bad,we chosed the URSL,but the stone was large and high location,we chosed PCNL.PCNL adapt combined spinal epidural anesthesia(CSEA) or general anesthesia,first the patient takes a lithotomy position, perineum routine disinfection,lay the asepsis list.We use the NS as the flushing liquor,then put the F9.5-Storz inflexible ureteroscope,find the ureter opening,and under the guidence of F5 ureter pipe,we examine the ureter by the ureteroscope untill we find the upper ureteral stone,then leave a F5 ureter pipe and F18 catheter.Second change prone position,list the waist to make a arch or loxosis position list the waist to form a 30 degree with the operating table. We make the waist routine disinfection,lay the asepsis list.In the guidence of the TVCDS we verticality puncture the pelvis at the eleven intercostal or twelve subclstal,when the urine comes out,we lay aside the safety guide wire,then make a small cut to expand the kidney puncture passageway from F8 to F16 by fascia dilator,then use the NS to the perfusate, put the URS into the collective system and find the jiont of the pelvis and ureter then enter the ureter untill you find the stone.We expand the kidney puncture passageway to F24.5 using the metal dilator,we take the F20.4 nephroscope in the direct horizon to the upper ureter where the calculi was.The lithotriptor is the third generation EMS,the feeler lever join the negative pressure equipment and NS priming pump(the perfusion presure is 100-180mmHg,the flow is 200-300ml/min),we can crush and discharge the stone at the same time.If the stone was not big,you can take them to the plevis to crush using the pliers.When the stone was too hard,we combine the air-presure trajactory and ultrasound to crush the stones.When we finish the operation we through the nephroscope put a F7 double J tube untill 4-8 weeks and left a F18 drainage tube in the renal puncture passageway until 3-5 days,finally we have to leave a catheter,if the urine color was a little red it implyed the urinary was unobstructed and the operation was over.URSL adapt combined spinal epidural anesthesia(CSEA), first the patient takes a lithotomy position, perineum routine disinfection,lay the asepsis list. We use the NS as the flushing liquor, put the F9.5-Storz inflexible ureteroscope,find the ureter opening,but you should be careful and enter the ureter slowly,not be blind,you should make sure the horizon be clear,and the quality of flow should be controled between 150ml/min to 180ml/min to avoid the stone coming back to the pelvic.As soon as you find the calculi,use the the air-presure trajactory to crack the stone continually,then take out the stone fragment use the URS pliers.If the stone is not big,you can bring the stones to the middle and bottom ureter to crack.If the stone was packed by the polyp we use the holmimium laser to incise them. When we finish the operation we put a F7 double J tube in the guidence of zabra guide wire untill 4-6 weeks and left a F16 catheter,the operation was over.We contrasted the PCNL to URSL before and after operation on the related data such as the stone clearance rate,fever, naked eye hematuresis length time, routine analysis of blood,hospital stays after operation, lithotripsy time, then we adopted chi-square test to statistical analysis.Results:Of 85 cases who underwent PCNL,84 achieved stone-free at one session, there were no residual stones in the KUB after operation, one patient whose ureter was circuity, the calculi could not be reached, finally underwent open surgery, and 15 of the patients in URSL whose calculi came back to the pelvis, three patients altered to PCNL, the other 12 patients needed Extracorporeal Shock Wave Lithotripsy after operation, the residual calculi in 3 patients incarcerated in the ureter again in one year, then they received the secondary URS, the rest 50 cases had no residual stones, the success rate was 76.9% in one session.In addition to this we contrasted the operation complication, lithotripsy time and so on between the two operation way.We thought PCNL was better than URSL on the calculi located at the upper ureteral.PCNL had a definite curative effect and a high stone clearance rate,also could reduce the second management.Conclusion:PCNL is superior to URSL in dealing with the calculuses located upper ureter, having a indeed effect and a higher stone cleaning rate, PCN also can reduce the secondary processes.