| Background:Renal pelvic or upper ureteral calculi larger in diameter than 2cm are common in clinical fields.They are often associated with hydronephrosis,infection and impaired renal function.Minimally invasive percutaneous nephrolithotripsy lithotripsy(PCNL)is the first choice in the treatment of these kinds of stones,but PCNL has the risk of bleeding,infection and damage of renal function after operation.With the development of laparoscopic technique,laparoscopic pyeloureterolithotomy are gradually applied in dealing with these stones.Objective:To evaluate the efficacy and safety of laparoscopic pyeloureterolithotomy(LP)and minimally invasive percutaneous nephrolithotripsy(PCNL)in the treatment of upper ureteral or renal pelvis calculi larger than 2cm.Methods:According to the criteria of inclusion and exclusion,40 patients with renal pelvic or upper ureteral calculi larger than 2cm from February 2016 to May 2017were in a retrospective analysis.According to the operation methods,the patients were divided randomly into laparoscopy group(LP)and percutaneous nephrolithotripsy group(PCNL).Among them,17 cases of LP group underwent laparoscopic pyeloureterolithotomy,23 cases of PCNL group received percutaneous nephrolithotripsy.To compare the safety and efficacy between the two groups,age,sex,stone diameter,distribution of stone location,infection rate of urinary tract,preoperative leukocyte,hemoglobin,serum creatinine(SCR)level,mean operation time,estimated blood loss,postoperative leukocyte,hemoglobin,creatinine(SCR)level,stone free rate,intraoperative and postoperative complications,mean hospital stay and mean hospitalization costs were recorded.Result:There was no significant difference in mean age(LP 51.17±13.39 vs PCNL48.00±11.13,P=0.418),sex(x~2=0.129,P=0.723),stone diameter(LP 2.41±0.57cm vs PCNL 2.62±0.81cm,P=0.364),distribution of stone location(x~2=0.175,P=0.68),infection rate of urinary tract(x~2=2.774,P=0.1),preoperative leukocyte(LP7.16±1.52(109/L)vs PCNL 8.84±3.55(109/L),P=0.076),hemoglobin(LP138.53±17.91g/L vs PCNL 137.78±21.04g/L,P=0.907),serum creatinine(SCR)level(LP 95±29.4umol/L vs PCNL 112.5±69.4umol/L,P=0.286)between the two groups(P>0.05).Although mean operative time(LP 113.35±21.48min vs PCNL103.35±31.68min,P=0.141)?mean postoperative leukocyte level(LP 11.60±2.88(109/L)vs PCNL 12.81±4.25(109/L),P=0.319)was no significantly difference between two groups,P>0.05.LP provided better results in estimated blood loss(LP18.82±3.76ml vs PCNL46.74±45.41ml,P=0.007),postoperative hemoglobin(LP125.53±15.81g/L vs PCNL 121.39±21.82g/L,P=0.035),serum creatinine(SCR)level(LP?94.02±29.26umol/L vs PCNL 107.62±64.47umol/L,P=0.039),stone free rate(LP 100%vs PCNL 65.2%,x~2=7.391,P=0.007),mean hospital stay(LP10.18±1.63d vs PCNL12.41±3.91d,P=0.022)and mean hospitalization costs(LP16180.65±2283.48 yuan vs PCNL 18694.96±2932.59yuan,P=0.006)which were significantly different between LP and PCNL groups,P<0.05.LP had no any complications during operation,2 cases of hypotension and 4 cases of perforation of renal pelvis happened in group PCNL during operation.LP had 1 cases of hematuria and 1 cases of fever,in the same time,PCNL had 5 cases of hematuria,6 cases of fever,3 cases of SCr increased after operation.Two groups had statistically significant difference in intraoperative and postoperative complications.Conclusion:1.For the treatment of upper ureteral calculi with diameter larger than 2cm,transabdominal laparoscopic pyeloureterolithotomy has the advantages of stonefree rate in one-stage operation,less bleeding,less intraoperative andpostoperative complications,and so on.2.The safety and clinical effect of LP in the treatment of upper ureteral calculi withdiameter greater than 2cm were superior to those of PCNL.3.This procedure can protect renal function to the maximum extent,especially forsingle kidney or functional solitary kidney. |
PDF Full Text Request