Application Of Intra-operative B-mode Ultrasonography In MPCNL Treatment Of Staghorn Calculi

Objective:To study application methods and skills of the intra-operative B-mode ultrasonography in MPCNL treatment of staghorn calculi. And the clinical effects were observed.Methods:Sixty adult patients with renal staghorn calculi that were admitted by the department of Urology, Second Affiliated Hospital of Kunming Medical University, from January2013to March2014were selected as subjects. All these patients received MPCNL treatment guided by B-mode ultrasonography using holmium laser lithotrity. The control group included30patients (including4cases of bilateral calculi).1or2percutaneous nephric tracts were established by the B-mode ultrasonography-guided. With direct vision through ureteroscope, each kidney calices was checked for calculi, and the surgery proceeded till no more stones could be found. The experimental group also included30patients (including5cases of bilateral calculi). The percutaneous nephric tracts were performed on the basis of the following steps. Firstly, an optimum percutaneous nephric tract to remove the calculi was established guided by the B-mode ultrasonography and remove the stone as far as possible by means of this first tract after studying carefully KUB, IVU and CT for ascertaining a rational tract. Secondly, during the operation, the kidney was scanned from multiple directions to guide clearance of pelvis stones, to locate accurately residual stones, and to guide the ureteroscope reaching for the stones. Thirdly, for the parallel or infundibula stenosis of calyces that impeded entering, a new percutaneous nephric tract was established guided by the B-mode ultrasonography. Finally, each calyx was scanned repeatedly with the B-mode ultrasonography, and the surgery was ended when no more stones could be found. Free stone rate, duration of operation, intra-operative bleeding, incidence of complications, post-operative hospitalization time, cost of operation and post-operative hospitalization. etc. were compared between two groups. Results:Free stone rate of the control group and the experimental group was22/34(64.7%) and32/35(91.4%), respectively, P<0.05. Duration of operation:the control group was102.75±24.63min, the experimental group was83.43±21.06min, P<0.05. Intra-operative bleeding:the control group was120.13±46.32ml, the experimental group was65.73±22.75ml, P<0.05. Post-operative infections:control group was in8cases (23.5%), the experimental group was in3cases (8.57%), P<0.05; Cases of blood transfusion:the control group was5cases (14.7%), the experimental group was0case (0%), P<0.05; Organ injury:none in the control group (0%), and one case of pleura injury in the test group (2.86%), P>0.05. Post-operative hospitalization days:the control group was9.5±2.75days, the experimental group was5.85±1.37days, P<0.05. Cost of operation and post-operative hospitalization:the control group was22645.27±8101.4RMB,the experimental group was12708.64±3437.38RMB,P<0.05.Conclusion:Systematic application of the B-mode ultrasonography can improve free stone rate of MPCNL to treat renal staghorn calculi, without extra time and cost for operation and post-operative hospitalization, and without increased complications, compared to those didn’t utilize systemic B-mode ultrasonography.