Comparison Of The Clinical Efficacy Of Percutaneous Nephrolithotomy And Flexible Ureteroscopic Lithotripsy In The Treatment Of Upper-ureter Calculi

Objective At present the main treatments of ureteral calculi are Extracorporeal Shock WaveLithotripsy(ESWL),Percutaneous Nephrolithotomy(PCNL)and Flexible Ureteroscopic Lithotripsy(F-URL).This article selects 154 cases of upper-ureter calculi patients,respectively treated by PCNL and F-URS method,analysis of the two kinds of operative methods calculi clearance rate,postoperative bleeding,postoperative complications,postoperative hospital stay,total hospitalization expenses and other related clinical data,compared to two kinds of surgery in the treatment of upper-ureter calculi.Methods From January 2015 to December 2017 a total of 317 cases of upper-ureter calculi patients required surgical intervention were admitted from the department of urology of the Second Affiliated Hospital of Soochow University.All the patients were Han Chinese adults.And patients' medical records were reviewed to exclude with elderly patients(?90y)with many complications,congenital renal malformation,severely obese,lowerureteric obstruction,calculi length-diameter greater than 20 millimeter,exist multiple precipitating factor of postoperative complication and other serious systemic diseases which effect postoperative hospital stay.Finaly Included in the study were 154 cases.By collecting history and clinical,use Scr to assess renal function,review KUB a mouth after treatment to assess calculi clearance rate.Operative time,postoperative hospital stay,hospitalization expenses,stone free rate and complication rate between two groups were recorded and compared.Results (1)General situation:Included in the study were 154 cases,including 78 cases ingroup PCNL and 76 cases in F-URL group.The average age was 50.50±15.27,Average calculi size was 13.72±4.37 mm.(2)Comparison between groups:There was no significant difference of transfusion rate,stone free rate,Infection cases between the two group(P>0.05).There were statistically significant difference of intraoperative blood loss,postoperative hospitalization days,higher values of serum creatinine and postoperative complications between the two group(P<0.05).(3)In group analysis: Females were more intraoperative bleeding than males in group PCNL;Calculi in ureter has higher stone free rate than calculi in UPJ in both two groups;The average CT value of calculi showed negative correlation with operation time in PCNL group(R=0.033,P<0.05),Intraoperative bleeding showed negative correlation with operation time in F-URL(R=0.045,P<0.05).Other indicators were not significantly related(P>0.05).Conclusion Both PCNL and F-URL are effective measures for the treatment of ureteral calculi with a diameter of less than 20 mm.The total stone free rate of PCNL and F-URL was basically the same,among which PCNL had a higher clearance rate of calculi in upper-ureter.The intraoperative blood loss,postoperative hospital stay and complication rate of F-URL were significantly less than that of PCNL.