Contrastive Study On Negative Pressure Combined Ureteroscope And Minimally Invastive Percutaneous Nephrolithotomy Of Upper Ureteral Calculi

Objective:To investigate the clinical efficacy of negative pressure combined ureteroscope and minimally invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper ureteral calculi,and to compare the efficacy and safety of the two surgical methods in the treatment of upper ureteral calculi(10~20mm).Methods:The relevant clinical data of 72 cases of upper ureteral calculi hospitalized in the department of urology of our hospital from December2017 to December 2018 were retrospectively analyzed.All the patients were diagnosed with unilateral upper ureteral calculi(stone diameter10mm~20mm),which were located between the ureteropelvic junction and the fourth lumbar vertebral plane.All patients had no contraindications to the operation,no previous history of renal ureterectomy on the affected side was excluded,and no anatomical abnormalities of the urinary system were found.Among them,37 cases were treated with negative pressure combined ureteroscope and 35 cases were treated with minimally invastive percutaneous nephrolithotomy.The differences in stone free rate,operation time,intraoperative blood loss,postoperative hospitalization time andpostoperative complications between the two groups were analyzed.Results:(1)The P values of gender,age,stone size,hydronephrosis degree,BMI and other general conditions of the two groups were all greater than0.05,with no statistical significance.(2)In the negative pressure combined ureteroscope group,3 cases failed to enter the ureteral due to ureteral stricture and tortuously,and the ureteral stent was indwelling during the operation.All the patients in the second stage were successfully treated with lithotripsy.The mPCNL group was successfully completed.(3)The stone free rate of the two groups were 86.5%(32/37)and 94.3%(33/35),with P > 0.05.The stone free rate at 1 month after surgery was 94.6%(35/37)and 100%(35/35),P > 0.05.The operative time was 39.45±7.76 min and 41.75±9.92 min,respectively,P > 0.05.The above differences were not statistically significant.(4)The intraoperative blood loss was 8.35 2.78 ml in the negative pressure combined ureteroscope group and 26.24 6.81 ml in the mPCNL group,respectively,P < 0.05.The postoperative hospitalization time was 3.08 1.06 days and5.43 0.95 days,respectively,P < 0.05.The differences were statistically significant..(5)Pass to recognize mirror set of 2 cases of postoperative fever,temperature > 38.5 ?,anti-infection improvement after symptomatic treatment.mPCNL group 2 cases of postoperative fever,temperature > 38.5 ?,anti-infection improvement after symptomatictreatment.One patient had severe postoperative hematuria,which was cured after conservative treatment.One patient showed delayed bleeding after the extraction of renal fistula 3 days after surgery,and conservative treatment was ineffective.The patient underwent selective renal artery embolization under local anesthesia,which gradually improved after surgery and discharged healthy.Conclusion:1.Negative pressure combined ureteroscope for the treatment of upper ureteral calculi has the advantages of less intraoperative bleeding,shorter postoperative hospitalization time and fewer postoperative complications.2.There was no significant difference in stone clearance rate and operation time between the two groups.