Clinical Study On Percutaneous Nephrolithotomy And Flexible Ureteroscopic Lithotripsy For Low Renal Caliceal Stones Under 2cm

Objective:To compare the clinical data of patients with renal calyceal calculi under 2cm treated by percutaneous nephrolithotomy and flexible ureteroscopy,and to explore the safety and efficacy of the two surgical methods.At the same time,multi-factor analysis was carried out on the single stone removal rate of flexible ureteroscopy,and the independent factors affecting the single stone removal rate were discussed,providing some reference for the selection of surgical methods for different patients in clinical practice.Method:The clinical data of 203 patients with lower calyceal calculi under 2cm who were operated by the same operation team in Qingdao municipal hospital affiliated to Qingdao university from June 2015 to June 2018 were analyzed retrospectively.they were divided into groups according to the operation method.77 patients received percutaneous nephrolithotomy were PCNL group,126 patients received flexible ureteroscopy were FURL group.The baseline characteristics,single stone clearance,operation time,postoperative hemoglobin decrease,postoperative hospital stay and postoperative complications of the two groups were compared,and the safety and efficacy of the two operations were analyzed.Meanwhile,the factors that may affect the single stone clearance rate of FURL group were analyzed by multiple factors to find out the independent factors that affect the single stone clearance rate of FURL group.Result:The single stone removal rate in FURL group was 81.75%(103/126)less than that in PCNL group was 92.21%(71/77),the difference was statistically significant(p < 0.05).the average operation time in FURL group was(75.49±11.44)min longer than that in PCNL group(54.01±9.73)min,the difference was statistically significant(p < 0.05).The average postoperative hospital stay(3.32 ±0.65)days and the average postoperative hemoglobin decrease(2.67± 0.91)g/l in FURL group were all less than the average postoperative hospital stay(7.16± 0.93)days and the average postoperative hemoglobindecrease(11.18 ±3.70)g/l in PCNL group,with statistically significant difference(p <0.05).The incidence of surgical complications in FURL group was 9.52%(12/126)less than that in PCNL group was 24.68%(19/77),and the difference was statistically significant(p<0.05).Multivariate analysis showed that the size of the stone and the size of the funnel angle of the renal pelvis and lower calyx are independent influencing factors on the single stone removal rate of soft ureteroscopy.the larger the stone,the lower the single stone removal rate(OR=1.501,p < 0.05);The smaller the funnel angle of renal pelvis and lower calyx,the lower the single stone removal rate(OR=0.952,p < 0.05).Conclusion:1.Flexible ureteroscopic lithotomy has the advantages of less trauma,faster recovery of patients and higher safety compared with percutaneous nephrolithotomy.2 Percutaneous nephrolithotomy is more effective than flexible ureteroscopy.3.The size of stone and the funnel angle of renal pelvis and lower calyx are the influencing factors for the curative effect of ureteroscopic lithotomy for lower calyx stone under 2cm.The bigger the stone,the worse the curative effect.The smaller the infundibulum angle of renal pelvis and kidney,the worse the curative effect.