A Comparative Study Of PCNL And Mini-PCNL Under Different Intrapelvis Pressure In Treatment Of Infectious Kidney Calculi

Objective:To compare the effects and complications of standard puncture passage percutaneous nephrolithotomy(PCNL, F24sheath) and mini-passage percutaneous nephrolithotomy(F16sheath) under high or low intrapelvis pressure in the treatment of infectious kidney calculi.Methods:The data of127cases of infectious kidney calculi treated with percutaneous nephrolithotomy between May2010and January2012in Shandong Jiaotong Hospital were collected. Intraoperative intrapelvis pressure was real-time monitored and patients were devided into high pressure group and low pressure group according to whether the accumulated time of intrapelvis pressure≥30mmHg is longer than10min. There were30cases of high pressure and35cases of low pressure in standard passage group, whereas the number were33and29in mini-passage group. The data of stage I calculi clearance, duration of operation, volume of intraoperative irrigation solution, intraoperative bleeding, result of intraoperative bacterial culture of intrapelvis urine and postoperative pain, fever, perinephric effusion and infectious shock in the four groups were analyzed statistically.Results:Stage Ⅰ calculi clearance were83.08%(54/65) and66.13%(41/62)(P<0.05) respectively in standard passage group and mini-passage group; operation duration were (71±6)min and (107±10)min(P<0.05); volume of intraoperative irrigation solution were (44600±1800)mL and (53500±3200)mL(P<0.05); average volume of intraoperative bleeding in the different groups were not statistically significant; positive rate of intraoperative urine bacterial culture in the different groups were not statistically significant; postoperative low and moderate fever(T<38.5℃) were35cases(53.85%) and45cases(72.58%) respectively in standard passage group and mini-passage group(P<0.05); postoperative high fever(T>39℃) were17cases(26.98%) and7cases(10.94%) respectively in high pressure group and low pressure group(P<0.05); high pressure group showed more severe lumbago, analgesic drug usage is significantly higher than low pressure group:16cases(25.40%) and6cases(9.38%), P<0.05. The incidence of perinephric effusion in high pressure group is also higher than low pressure group:17cases(27.05) and7cases(10.9%), P<0.05. Infectious shock was only found in high pressure of mini-passage group with only2case who was successfully rescued.Conclusions:1. Standard puncture passage percutaneous nephrolithotomy has the advantage of high calculi clearance, short operation duration, less amount of irrigation solution.2. The incidence of postoperative fever, analgesic drug usage and perinephric effusion of percutaneous nephrolithotomy is related with intraoperative high pressue in pelvis; and no significant statistical correlation between PCNL and MPCNL.3. Standard puncture passage percutaneous nephrolithotomy does better in treatment of infectious kidney calculi with low intrapelvis pressure and short time in high intrapelvis pressure by improving effects and lowering operative complications.