The Application And Flighting-determination Of Minimally Invasive Endoscopic Surgery To Cure Upper Urinary Tract Stones Of Pilots

Objective:1.By evaluating the safety,efficacy,cure rate and the impact on flighting-determination of minimally invasive endoscopic surgery on pilots with upper urinary tract stones,we aimed to quantify the reasonable treatment plan to improve the cure rate and shorten the treatment or ground observation time.2.To assessment the diagnostic and treatment capability of minimally invasive endoscopic surgery on the Randall plaque,and explore the special flighting-identification standards of pilots with Randall plaque,which can reduce the limitation rate of single –seat fighter pilots and maintain the air force.Methods:From October 2006 to March 2017,pilots with newly diagnosed upper urinary tract stones were enrolled into this retrospective study.Their clinical characteristics including age,height,weight,past medical history,aircraft,flighting-time,flightingidentification,final diagnosis and follow-up results were collected.On the basis of cured type,patients were divided into two groups as Extracorporeal Shockwave Lithotripsy(ESWL)group and minimally invasive endoscopic group.Minimally invasive endoscopic surgery mainly included ureteroscopic lithotripsy(URS),percutaneous nephrostolithotomy(PCNL)and retrograde intrarenal surgery(RIRS).Age,body mass index(BMI),average days of treatment,the length diameter and CT value of stone were compared between the two groups.According to postoperative diagnosis,the pilots who were cured by PCNL and RIRS were divided into calcuil in renal collecting system group(small renal calculi group)and the Randall plaque group.Similarly,we compared these patients with age,BMI,the length diameter and CT value of stone.To further validate the safety and feasibility of flight for single-seat flight pilots with calculi,the final diagnosis,flighting-identification and follow-up results were taken into account.Results:122 pilots with upper urinary tract calculi met the inclusion criteria,including 80 cases of renal calculi and 42 cases of ureteral calculi.All patients were male(age:21-50 years,weight: 61kg-83 kg,height: 169cm-183 cm,BMI: 22.6 Kg/m2-27.9Kg/m2,the length diameter of the stones: 0.2cm-1.5cm,the CT value of stones:153Hu-1706 Hu,flying time: 340 hours-7260 hours).Aircraft species covered fighter,trainer,transport planes,bombers and helicopters.51 pilots were cured by EWSL and permitted to fly again.Among the 51 pilots,32 cases were diagnosed as ureteral calculus,with the remainders being defined as renal calculus.On the contrary,58 patients were cured by minimally invasive endoscopic surgery,including 10 cases of ureteral calculus,18 cases of calcuil in renal collecting system,27 cases of Randall plaque and 3 cases of Randall plaque combined with small stones in renal collecting system.6 patients with kidney stones were forced to stop flying and 7 single-seat flight pilots transformed into double-seat flighter.22 single-seat flight pilots with Randall plaque who were licensed to fly under close observation,which avoided being limitted to fly.When we compared ESWL group with minimally invasive endoscopic group,we found the latter had shorter treatment time,and the difference was statistically significant(P < 0.05).No significant differences between the two groups were observed in age,BMI,the length diameter of the stones,and the CT value of stones(P > 0.05).Compared with Randall plaque group,pilots with calcuil in renal collecting system had higher level of the length diameter and CT value of stones,and significant statistical differences were existed(P(27)0.05).However,there was no significant difference between the two groups in the age and BMI(P > 0.05).Conclusion:1.Minimally invasive endoscopic surgery is a safe and effective treatment,which can help the pilots with the refractory upper urinary tract calculi to avoid being grounded and fly again.Besides,minimally invasive endoscopic surgical technique can improve therapeutic efficiency,shorten the time of ground observation.2.Minimally invasive endoscopic surgery can be beneficial to make a definite diagnosis of Randall plaque.Therefore,it is trustworthy that minimally invasive endoscopic surgery will make the diagnosis and treatment system of renal calculi for pilots more perfect.