| Staghorn calculi was in renal pelvis and full of at least1renal calyceal. PCNL has become the gold standard for treatment of staghorn calculi recent years, replaced the open operation gradually. However, because of the stone burden and dispersion, a single channel operation is difficult to clean the stone, in order to improve the stones free rate,and avoid complications such as bleeding, a variety of programs were tried by surgeons, such as multi-channel PCNL, combined ESWL staging stone etc. Several schemes was combined actually in order to improve the efficiency of operation and ensure the safety.In recent years, many centre adopted establishing mutil-channel in I stage. But the microchannel stone removal efficiency was not high, and II stage PCNL was performed after I stage PCNL,there are still higher probability of operation, so recently scholars have put forward establishing mutil-channel after the first channel became mature, due to Ⅱ stage operation has less bleeding, clear vision, it can reduce the complications such as bleeding, adjacent organ injury, and benefical to improve the stone-free rate. and big channel with micro-channel was performed combinedly. The cases of establishing multi channel in first stage and second stage was analysis retrospectivly n first part of the study, it aimd to put forward the better scheme for mutil-channel PCNL.In the first stone process, there was residual stones because of intraoperative hemorrhage or long operation time or the the angle of nephroscope was limited by single channel,, larger residual stone need to perform II stage operation. For the II stage operation scheme, there are common scheme such as combining ESWL and establishing multi-channel in II stage etc. The scholar thinks," sandwich" therapy (PCNL+ESWL+PCNL) helps to reduce the complications, improve the stone-free rate. ESWL can crushed stone which is difficult to manage in PCNL.Compared to the single PCNL, combined treatment reduced the number of channel and the complication of PCNL. At the same time, the combined treatment of ESWL can use low power, it can reduce the large dose of shock wave lead to the body damage, has the advantages for safe operation, small trauma, less complications. However the ESWL can achieve the ideal therapy effect and reduce the number of channels at the same time? Actually the establishment of multi channel stone would increase the complication rate? It is necessary to combined ESWL in the staging operation? The cases of original channel PCNL in II stage after combine ESWL and establishing multi-channel in II stage was analysis retrospectivly in second part of the study, it aimd to put forward the better sugestion for Ⅱ stage PCNL.First section Comoparison the Efficacy of Establishing Mutil-channel in First-stage and second-stage of Percutaneous Nephrolithotomy for staghorn renal stoneObjectiveTo investigate the effect and safety of establishing mutil-channel in first-stage of percutaneous nephrolithotomy(PCNL) compared with establishing mutil-channel in second-stage of PCNL in the management of staghorn renal stone.Methods:79patients underwent Mutil-channel PCNL in treatment of staghorn renal stone were retrospectively reviwed from Jan.2007to Dec.2011.31cases in group I underwent established mutil-channel PCNL in first-stage and48in group Ⅱ in second-stage.Case selection criteria:routine preoperative KUB, IVP examination, diagnosised staghorn calculus. The calculus with single or multiple renal pelvis and calyces. Compare related datas about these cases.Group I patients was performed the lithotomy position, transurethral resection insert ureteral catheter, for the benefit of artificial urinary tract development and artificial hydronephrosis; changing body position to the prone position, the ureteral catheter injected contrast agent, Under C arm X-ray positioning or B ultrasound localization with scapular line and the posterior axillary line between the11and12ribs, intercostal the scope for puncture, then t used fascia dilator establing the channel, indwelling20F standard channel gradually. Take12F minimally invasive nephrscope placement, with the f infusion pump under display monitor with pneumatic ballistic lithotripsy, holmium laser or (60W) crushed stones. According to stone location, and add the t micro channels (14or16F), rush the stone out after lithotripsy. Indwelling double J tube and renal fistula.Group II:Patients was established20F standard channel with X-ray location, crushed stone indwelling fistula, after3days,review the X radiographs, understanding of residual stone location,5-7days through its original channel place guide wire, removal of fistula, established second and third channel under X-ray location or monitor by nephrolithotomy.The process of lithotripsy was the same above.Collected the data of two groups after treatment using SPSS13to statistically analyzed, count data by usingx2test, measurement data using t test, analysis and compare the data about the two groups.Results:the stone free rate was67.7%(21/31) in first-stage,10case need second time operation, the final stone free rate was90.3%(28/31), vs93,7%(45/48) in Group Ⅱ,the operation time was104.064±35.932min vs108.333±12.313min there was no statistically difference between them(P>0.05).The hospital staying was (11.290±3.358daysvs16.270±1.620days), postoperative hemoglobin dropped (23.709±3.866g/L g/L vs17.791±4.057g/L), there was statistically difference between them (P<0.05). The two groups were not infectious shock. Postoperative fever was6cases in stage I group, was3cases in stage II group, the temperature were decreased to normal in3days by the anti-inflammatory treatment;4cases of group I was postoperative hemorrhage vs2case of group Ⅱ, group I required a blood transfusion in5cases, group Ⅱ3cases. Pleural injury, pneumothorax, group I has2cases, accounting for9.5%, group II was1patients,2%. Total complications:15cases of I group, II group has6cases, significantly less than the group I.Conclusions:1Both establishing mutil-channel in first-stage PCNL and second-stage PCNL for stag-horn stone has high stone free rate; there was no statistically difference between them2Establing mutil-channel in II stage PCNL has less complications than establishing mutil-channel in I stage PCNL.3About33%of patients in group of establishing mutil-channel in I stage PCNL still need operation again, and its complications more than that of stablishing mutil-channel in II stage PCNL, it is suggest that establishing mutil-channel in II stage was safer and less complications. Second section Comoparison the Efficacy of Combine ESWL and mutil-channel in Stage PCNL for staghorn renal stoneObjective:To investigate the effect and safety of establishing mutil-channel in second-stage of PCNL,compared with original channel PCNL in second-stage after combined ESWL in the management of staghorn renal stone.Methods:104patients underwent single channel PCNL in treatment of staghor renal stone were retrospectively reviwed from Jan.2007to Dec.2011.The residual stone stayed in one pelvis at least,the length of it was15mm.48cases in Group Mutil-Channel underwent established mutil-channel in Second-stage and56cases in Group Combine ESWL undrwent original channel PCNL in second-stage after combined ESWL.Retrospectively analyze the2007.1-2011.12of104patients with first single channel PCNL in the treatment of postoperative residual stones of maximum diameter of KUB,15mm and at least1residues of calyceal renal staghorn calculi patients, divided into a combined ESWL channel (PCNL group combined treatment group) in56cases, including37male cases,19cases of female.Ⅱ based multi channel group PCNL (multi channel group) in48cases, including30male cases, female18cases,39cases of double channels and three channels of9cases. Two groups of patients were for the first time after treatment of indwelling double J tube and renal fistula, postoperative gives anti-infection, support for the treatment of. Using12F WOLF nephroscope, domestic hydraulic injection pump, pneumatic lithotripsy and holmium laser lithotripsy system, C arm machine, HK-V extracorporeal shock wave lithotripsy.Treatment options:combined treatment group: single channel PCNL after first treatment for about a week, using ESWL treatment, after3days to review the KUB, after nephrostomy fistula draining liquid cleaner again when the original channel PCNL stone. Multi channel group:II operation set up second or three channel.Operation method:ESWL:with the prone position, voltage was14-16KV, the number of impact was2000～2500times;, KUB examination after3days, once again through the original channel PCNL therapy.PCNL:the combined treatment group:patients take a prone position, from the original fistula put into the nephroscope, with holmium laser crushed stones. High pressure water rush the stones out of the body. Indwelling double J tube and into the renal fistula.The multi-channel group:patients taking the prone position, inject contrast agent from the fistula, under C arm positioning, punctured the renal in the aera of scapular line and the posterior axillary line, the11intercostal space and12rib, using fascia dilator channel, establish second or third16F channel, Use pneumatic ballistic or holmium laser lithotripsy.Collected the data of two groups after treatment using SPSS13to statistically analyzed, count data by usingx2test, measurement data using t test, analysis and compare the data about the two groups.Results:Compared of the clearance rate of stone, the Group Combine ESWL was80.3%(45/56) and Group Mutil-Channel was93.7%(45/48), days staying in hospital was19.642±2.219days vs16.270±1.620days.there was statistically difference between the two groups (P<0.05).the operationg time was44.946±8.449min VS45.604±7.813min, postoperative hemoglobin dropped6.000±2.062g/L VS6.729±2.121g/L, there was no statistically difference between the two groups. The two groups have not infectious shock, peripheral viscera injury and other complications. Postoperative fever combined treatment group was3cases, multiple channel group was3cases, the temperature dropped to norma after antibolic treatment after3days; Multi channel group3case(6%) required a blood transfusion, combined treatment group was2cases (3%).Conclusion:1The effict of stage mutil-channel PCNL was better than combine threapy. It suggest that the value of combining ESWL was limited between two operations.The complication of establishing mutil-channel was not increase and can reach higher stone-free rate;2The patiens who perform stage mutil-channel PCNL need less expenses and shorter time staying in hospital. |
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