| Objective: To evaluate the efficacy and safety of percutaneous nephrolithotomy(PCNL)for treatment of renal calculi with self-made optic puncture system under ultrasound guidance.Methods: A total of 124 patients with kidney stones were treated in our hospital from January 2017 to April 2018.62 patients of the observation group underwent PCNL with self-made optic puncture system under ultrasound guidance,and other 62 patients of the control group underwent PCNL with traditional non-optic puncture under ultrasound guidance.The mean age is 51.8 years(range 26-70 years)and 52.8 years(range 30-73 years)respectively.The average stone diameter is 4.2 cm(range 1.8-8.0 cm)and 3.9 cm(range 2.0-8.1 cm)respectively.Based on results of B-ultrasound in our hospital,the patients of both groups were divided into subgroup of overall patients,subgroup of patients with mild hydronephrosis and subgroup of patients with moderate or severe hydronephrosis(the patients without hydronephrosis belonged to subgroup of patients with mild hydronephrosis).Clinical data including the time of puncture,the rate of working channel loss,the time of hospitalization,the decrease of Hb,the rate of transfusion,the rate of repeated puncture and the postoperative complications such as the rate of collection system rupture,fever and septic shock were compared.Result: 16 F percutaneous work access were successfully established in the two groups,and phase-I lithotripsy was performed in all patients.In the observation group,there were 47 patients with mild hydronephrosis and 15 patients with moderate or severe hydronephrosis;in the control group,there were 40 patients with mild hydronephrosis and 22 patients with moderate or severe hydronephrosis.There were a significant differences in the time of puncture between the two groups.The time of puncture were(6.4 ± 2.2)min and(9.9 ± 3.5)min(P < 0.01)in overall patients of two groups respectively;The time of puncture were(7.2 ± 1.7)min and(11.7 ± 2.8)min(P < 0.01)in patients with mild hydronephrosis of two groups respectively;and The time of puncture were(3.7 ± 1.2)min and(6.7 ± 2.1)min(P < 0.01)in patients with moderate or severe hydronephrosis of two groups respectively.In the overall patients and patients with mild hydronephrosis,there were significant differences in the time of hospitalization between the two groups.The time of hospitalization were(4.0 ± 0.7)days and(4.4 ± 0.6)days(P = 0.002)in overall patients of two groups respectively and(3.9 ± 0.7)days and(4.4 ± 0.6)days(P = 0.002)in patients with mild hydronephrosis of two groups respectively.However,there was no difference in the time of hospitalization between patients with moderate or severe hydronephrosis of two groups,P > 0.05.In the overall patients and patients with mild hydronephrosis,there were significant differences in the decrease of Hb between the two groups.The decrease of Hb were(9.8 ± 6.6)g / L and(17.0 ± 10.9)g / L(P < 0.01)in overall patients of two groups respectively and(10.0 ± 8.8)g / L and(14.4 ± 10.1)g / L(P < 0.01)in patients with mild hydronephrosis of two groups respectively.However,there was no difference in the decrease of Hb between patients with moderate or severe hydronephrosis of two groups,P > 0.05.The rates of transfusion were lower in overall and mild hydronephrosis paients of obversation group.They were 1.6 % VS 12.9 %,P = 0.03 and 0% VS 15.0%,P = 0.020;However,it was no difference in moderate or severe hydronephrosis paients between two groups,P >0.05.In overall patients,mild hydronephrosis and moderate or severe hydronephrosis paients of obsevation group,the rates of collection system rupture were 0% and the rates of repeat puncture were 1.6 %?2.1% and 0% respectively;In the patients of control group,the rates of collection system rupture were 9.7 %?12.5% and 4.5% and the rates of repeat puncture were 12.9 %?15.0% and 9.1% respectivly.In the terms of the rates of collection system rupture,there were significant differences in overall patients and mild hydronephrosis patients(P < 0.05)but no difference between moderate or severe hydronephrosis paients(P > 0.05).In the terms of the rates of repeat puncture,there was significant difference only in overall patients(P = 0.038)but no differences in mild hydronephrosis patients and moderate or severe hydronephrosis paients(P > 0.05).There was no significant difference in the rate of working channel loss,postoperative fever and septic shock(P > 0.05).Conclusion: PCNL with self-made optic puncture system for treatment of renal stone under ultrasound guidance is associated with shorter puncture time and hospitalization time,higher rate of puncture success,less the rate of collection system perforation and hemorrhage than PCNL with traditional non-optic puncture.The advantages of PCNL with self-made optic puncture system were more obvious in patients with mild hydronephrosis.This approach may be suitable for those patients with no or mild hydronephrosis and those doctors with little experience. |
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