A Study On The Stone Fragmentation And Renal Dysfunction Of Different ESWL Energy On Renal Stones In Tibet

Objective To explore the effect of energy on lithotripsy stone fra-gmentation rate and renal function injury in ESWL?Extracorporeal shock wave lithotripsy?patients with renal Calculi in Tibet region.To summari-ze the clinical problems and application experience of ESWL in the treat-ment of kidney Calculis,and to select a safe and effective shock wave en-ergy range suitable for ESWL treatment in kidney Calculi in this area.Methods According to the inclusion and exclusion criteria,a total of 90 patients with kidney Calculi were selected from the People's Hospi-tal of Tibet Autonomous Region from June 2016 to August 2017.Accord-ing to the randomized comparison table method,90 patients were random ly assigned to three groups of ESWL energy.Low-energy group-A group?5-7W?30 cases,middle-energy group-B group?8-10W?30 cases,high-energy group-C group?11-13W?30 cases,all patients were treated with ESWL according to different energy ranges.Collect the general clinical data of every patient?age,sex,stone site,stone size,body mass index,CT value of calculus,etc.?,and before treatment,2 days,7 days and 14 days after treatment serum cystatin Suppressor C,blood?₂-microglobulin,urine?₂-microglobulin values and hematuria,fever,pain,Steinstrasse and other complications in each group;all patients were treated with X-rays or 2 weeks after treatment.B-ultrasonography,CT scan review,residual Calculi with long diameter?4mm,re-treatment,the total number of ES-WL?3,three months after the last treatment review X-ray or B-ultrasound,CT;record the rate of the first Calculi clearance and the total Calculi clearance rate after treatment,efficacy indicators such as clearing rate;Collect and analyze the constituents of the Calculi from the discharged stones;Use SPSS statistical software to analyze and compare the data.Results1.Effect of gravel On the effect of ESWL in middle energy group?B?and high energy group?C?is better,the first Calculi clearance rate of 56.67%and 60%,and the total Calculi clearance rate was 76.67%and 73.33%were significantly higher than the first Calculi clearance rate26.67%and the total stone clearance rate was 46.67%in group A,the difference was statistically significant?P<0.05?.Results show that the use of high energy,low energy ESWL effect of lithotripsy stone fragmentat-ion rate.The first Calculi clearance rate of group B of was slightly lower than the group C,while the B group of the total stone clearance rate was slightly higher than the group C,but the difference was not statistically significant?P>0.05?.Show that:This study use middle-energy and high energy ESWL effect of lithotripsy stone-fragmentation rate is not signifi-cantly different.2.Renal dysfunction On the second day after ESWL,serum cys-tatin C,serum?₂-microglobulin,and urinary?₂-micro-globulin were in-creased in all the three groups of patients.There was no significant dif-ference between the low and middle energy groups?P>0.05?;Each of the index kidney dysfunction in the high energy group was significantly high-er than that in the low and middle energy groups,and the difference was statistically significant?P<0.05?.Seven days after ESWL,serum cystatin C returned to preoperative levels in all three groups,there was no signifi-cant difference between the three groups?P>0.05?;Serum?₂-microglo-bulin and urinary?₂-microglobulin were detected in low and middle ener-gy group,returned to preoperative levels,with no statistically significant difference between the groups?P>0.05?;Although the high-energy group had blood?₂-microglobulin and urinary?₂-microglobulin,Partially re-turned to the normal reference range,but the difference was statistically significant compared with the low and middle groups?P<0.05?.Fourteen days after ESWL,the renal injury indicators of all three groups returned to preoperative levels,there was no significant difference between the three groups?P>0.05?.3.Complications The incidence of skin damage after ESWL treat-ment in the three groups of patients was significantly higher in the high-energy group?33.33%?and the low-energy group?3.33%?and the mid-dle-energy group?10%??P<0.05?;Pain?need to have analgesic drug intervention?,hematuria,fever,although the incidence of high-energy group was higher than low,moderate energy group,but the difference was not statistically significant?P>0.05?;The incidence of all compli-cations after ESWL in low and middle groups was compared,the dif-ference was not statistically significant?P>0.05?.None of the three groups of patients had"Stein-strasse"after ESWL.4.Analysis of the composition of renal Calculis 75 cases of kidney Calculi?X-ray positive?were collected in the study.All the components detected in kidney Calculis were mixed Calculis,accounting for 61.33%of all Calculis.The most common component of carbonate apatite was oxalate monohydrate+apatite carbonate composition?21.33%?,followed by calcium oxalate monohydrate+calcium oxalate dihydrate?17.33%?;The single component calculus was only calcium oxalate monohydrate?38.67%?.From the analysis of the proportion of each Calculi constituent,calcium oxalate accounted for the highest proportion of 94.67%,and oth-er components were rare;There was no significant difference in the com-position of Calculis among the groups?P>0.05?.Conclusion1.Energy size affects ESWL effect of lithotripsy stone-fragmentation rate.2.The kidneys showed transient damage after ESWL treatment;When the energy was?11W,the kidney injury increased significantly.3.It is recommended to treat 8-10W energy in ESWL pati-ents with kidney stones in this area.