| ObjectiveTo evaluate the effects of semi-supine lithotomy position combined with prograde irrigation on stone elimination in ureteroscopic lithotripsy(URL).MethodsA total of 80 patients with ureteral calculi who undergo URL were selected as subjects from September 2017 to August 2018.Participants were randomized in a ratio 1:1 to the control group(n=40)and the experimental group(n=40).Patients in control group received conventional ureteroscope lithotripsy combined lithotomy position and backwashing.In the experimental group,on the basis of the lithotomy position,the affected hip and knee joints were flexional placed at 120 degrees and 150 degrees respectively,and then the operation bed was adjusted to the improved lithotomy position of 25 degrees oblique supine with high head and low hip(i.e.semi-supine lithotomy position),and fixed properly.Before ureteroscopic lithotripsy,a 5F single J tube was placed above the stone through a guide wire,and then the single J tube was connected with a perfusion pump to carry out prograde Irrigation.The data of stone migration,operation time,vital signs and complications such as ureteral perforation and peripheral organ injuries,etc.were recorded during operation.plain film of kidney-ureter-bladder(KUB)plain film and B ultrasonic examination were performed 3 days after operation to determine whether the stones were residual;reexamined renal function(serum creatinine,urea nitrogen);and the vital signs,blood routine and urine routine were monitored to determine whether there were any postoperative infection.Forty days after operation,B-mode ultrasonography was performed to determine whether patient had a ureteral stricture.ResultsThere were 12 cases withdrawing from the study,8 in the control group,and 4 in the experimental group.Two groups of patients were successfully performed with URL.In the control group,stones were shifted to the kidneys in 7 cases(21.9%),and stones in the experimental group were shifted to the kidneys in 1 cases(2.8%),and the displacement of calculi in the experimental group was significantly less than that in the control group(P<0.05).The operation time were(68.09±4.99)minutes and(57.19±6.94)minutes respectively in the control group and experimental group,and the operation time of the experimental group was significantly less than that of control group(P<0.05).The vital signs of the two groups were relatively stable during operation,and there were no significant difference in systolic pressure,diastolic pressure,heart rate,blood oxygen saturation and respiration between the two groups(P>0.05).There were no serious complications such as ureteral perforation and peripheral organ injury in the two groups.There were 8 cases(25.0%)of the patients in the control group and 1 cases(2.8%)in the experimental group with stone residue,the number of calculus residue in the experimental group was significantly lower than that in the control group(P<0.05).There was no statistically significant difference in the levels of postoperative serum creatinine and urea nitrogen(P>0.05).There was no statistically significant difference in the incidence of postoperative infection,ureteral stenosis and other complications(P>0.05).ConclusionCombined semi-supine lithotomy position and prograde irrigation in the treatment of ureteral calculi can prevent the stone upward displacement,shorten the operation time,reduce the postoperative calculus residue rate reduces,but not increase the complication incidence rate of surgery,improve the effect of clearing stone and operation efficiency on the basis of guaranteeing the safety of operation.,it provides a practical basis and treatment method for preventing residual calculi. |
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