| Objective:Discussion on the safety and clinical effect of PCNL.Methods:86 cases of solitary kidney calculi received PCNL in Urology Department of The First Affiliated Hospital of GuangXi Medical University from January of 2013 to December of 2015 were enrolled.51 males and 35 female patients, the age range from 17-73 years old, the average was 50.9±11.5 years old.9 of them were diagnosed with anatomical solitary kidney,77 cases were functional solitary kidney.46 cases were left side solitary kidney while 40 cases were right side. The diameter of calculus ranged between 0.5-8.8cm the average diameter was 2.82±1.68cm, in those 60 cases, the diameter of the calculus were greater than 2cm.6 cases were solitary calculus,73 cases were multiple calculi,7 cases were staghorn calculi.70 cases were simple renal calculi.2 cases were UPJ calculi and 14 cases were renal stone combined with ureteral stone. Kidney function test, blood routine, urine routine, urine culture were done before surgery, antibiotic treatment were chosen empirically or according to the drug sensitivity test. We analyzed the duration of operation, bled volume during operation, Scr before and after surgery, clearance rate of calculi, postoperative complications and postoperative hospital stay.Results:among these 86 cases,13 of them were complicated with hypertension,5 cases were complicated with diabetes mellitus,62 were complicated with urinary tract infection,14 cases were positive in urinal culture. Preoperative Hb was 116.67±20.07g/L.Preoperative SCr was 190.0±13.8μmol/L. 6 cases had PCN or ureter retrocathetersim because of pyonephrosis or renal dysfunction due to obstruction, they received PCNL after the infections were controlled and renal function improved.6 cases received hemodialysis for 1-13 times preoperatively. All patient underwent a successful surgery, the average duration of operation was 101.0±36.6min, the average bled volume was 56.7±75.0ml. Hb was tested the first day after operation:110.83±18.93g/L, which was lower than preoperation, but without a significant difference(P>0.05).SCr was also tested the first day after operation: 217.5±15.4μmol/L, which was higher than preoperation, but without a significant difference(P>0.05). No one had opening surgery in our study,4 cases were postoperative febrile(38.5℃-39.2℃),4 cases were diagnosed with SIRS after surgery.7 cases received blood transfusion after surgery, one of them received SSRAE treatment to control the bleeding. One patient received closed thoracic drainage after pneumothorax.2 cases received hemodialysis because the increased SCr. The stone removal rate in one section was 60.5%(52/86),32 received the second section and the clearance rate was 84.9%(73/86),5 cases received the third section, the total stone free rate was 89.5%(77/86). The postoperative average hospital stay were 9.5±4.7 days.In our study,65 cases received single tract PCNL and 21 cases received two tracts PCNL. In single tract group, preoperative examination such as Hb 117.82±2.51g/L, SCr184.3±15.0μmol/L, bleeding volum during surgery: 48.2±60.2ml, first day after surgery we checked the patients’ Hb: 111.49±2.47g/L, SCr214.4±17.6μmol/L, stone free rate in first section was 60.0%(39/65); compared with the first group, the examinations in two tracts group were showed as following:preoperation Hb113.10±4.26g/L, SCr207.4±32.3μmol/L, blood lost during surgery was 83.1±106.6ml, first day after operation:Hb108.75±15.71g/L, SCr227.2±32.5μmol/L, stone free rate in first section was 61.9%(13/21). By comparing the Hb/SCr/blood lose and stone free rate in first section in these groups, there was no significant difference (P>0.05). The operation duration in single tract group was 108.1±47.4 min with the complication rate which was13.8%(9/65), operation duation in two tracts group was 137.8±45.3min with the complication rate which was 42.9%(9/21), two tracts group showed a longer operation duration and greater complication rate with statistically difference (P<0.05).Conclusions:PCNL in treating solitary kidney calculi was featured with higher stone clearance rate and less complications, which was a safe and effective treatment. |
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