The Study Of CT Value Of Urinary Calculi On The Clinical Effect Of Percutaneous Nephrolithotomy And Flexible Ureteroscopic Lithotripsy

Objective: To study the effect of CT value of urinary tract calculi on the efficacy and safety of PCNL(Percutaneous nephrolithotomy)and FURL(Flexible ureteroscopic lithotripsy)as well as explore its clinical application.Methods : The data of patients with upper urinary tract stones treated with PCNL or FURL from February 2016 to August 2018 in the Department of Urology,Sichuan Provincial People's Hospital were retrospectively analyzed.According to the enrollment and exclusion criteria,a total of 126 patients were admitted.Among them,66 patients in the PCNL group(group A)and 60 patients in the FURL group(group B)were divided into A1 and B1 subgroups according to the CT value of 800 Hu and the stone size of 2cm(CT value>800Hu,stones>2cm),A2,B2 subgroup(CT value >800Hu,stone <2cm),A3,B3 subgroup(CT value <800Hu,stone > 2cm),and A4,B4 subgroup(CT value <800Hu,stone <2cm).After the management with PCNL or FURL,the differences between the two groups in terms of Stone Free Rate(SFR),operation time,length of hospital stay,bleeding,and inflammatory indicators reflectinginfectionwereanalyzed.Results: 1.Stone clearing rate(SFR): The total stone clearing rate of group A and group B was 90.9% in group A and 63.3% in group B,and the difference was statistically significant(P<0.05).For subgroup comparison,the rate of stone clearing stone in group A1(87.5%)was better than that in group B1(40.0%)(P<0.05),and the difference between group A2(92.3%)and B2(41.7%)was also statistically significant,however,The difference in the rate of stone clearing between group A3(88.2%)and in group B3(80.0%)or between the A4 group(95.0%)and the B4 group(83.3%)was not statistically significant(P>0.05).2.Comparison of operation time: The difference was statistically significant in the total operation time of the two groups,and the time in group A(56.33±11.97min)was less than group B(64.71±16.22min).In Subgroup comparison,the time in group A1(60.35±12.37 min)was less than Group B1(77.13±17.81 min)(P<0.05),The time in group A2(60.38±12.26min)was less than group B2(71.76±13.11 min)(P<0.05),and the difference between group A3(56.16±10.76 min)and B3(64.35±9.27 min)was statistically significant(P<0.05),showing the operation time of group A3 was less,however,the difference between A4(50.62±10.86 min)and B4(49.94±8.20 min)was not statistically significant and the operation time in group A4 was similar to that of group B4.3.Comparison of hospitalization time: The total hospitalization time was compared in group A(6.07±1.93 days)and group B(4.32±1.83 days),it was found that the difference was statistically significant(P<0.05).For subgroup analyses,the time in the group A2 was(6.45±1.66)days and(4.21±1.10)days in B2 group,and it was(6.04±1.86)days in group A3 and(3.79±1.36)days in B3.It was found that the difference between A2 and B2 or between A3 and B3(P<0.05).The hospitalization time in group B2 or B3 was shorter than that in group A2 or A2.However,the hospitalization time in group A1 group(7.13±1.96 days)was not different significantly from group B1(6.50±1.26 days)(P>0.05).4.Comparison of postoperative bleeding: 9 patients with intraoperative and postoperative hemorrhage occurred in group A,2 of which were more severely bleeding,including one occurred within 24 hours after surgery(inter-arterial artery hemorrhage)and another occurred in six days after operation(pseudoaneurysm).All the two patients improved after undergoing superselective renal artery embolization.The other 6 patients were treated with absolute bed rest,symptomatic and other conservative treatments.Only one patient in group B developed significant bleeding after surgery.There was a significant difference between the two groups(P<0.05),and group B was significantly less than group A in postoperative bleeding.5.Comparison of inflammatory indicators: Both groups of patients showed abnormal levels of inflammatory response,including elevated body temperature,elevated C-reactive protein,elevated white blood cells,and elevated calcitonin.Three patients in group A had abnormal inflammatory response,and developed systemic inflammatory response syndrome(body temperature over 38 °C,WBC>12*109/L),and one case developed urinary sepsis.20 patients in group B had abnormal inflammatory response,and 6 of them developed systemic inflammatory response syndrome(body temperature over 38 °C,WBC>12*109/L),2 cases of urinary sepsis occurred,the degree of which was heavier than the percutaneous nephrolithotomy group.The patients with sepsis were transferred to the ICU for treatment with carbapenem antibiotics.Overall,the probability of infection in group B was higher than that in group A,especially in group A1 and group B1 with CT value >800Hu and stone >2cm(P<0.05).The difference was statistically significant.Conclusions: 1.Percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy have similar stone clearance and operative time when the CT value of the stone is <800Hu and the stone diameter is less than 2cm.However,the ureteroscope has a shorter hospital stay and less bleeding complications.2.If the CT value of the stone is >800Hu and the diameter of the stone is <2cm,as well as the time of the gravel is estimated to be long,minimally invasive percutaneous nephrolithotomy should be selected.3.With the stone CT value <800Hu and 2cm < stone diameter <3cm,you can choose one stage of flexible ureteroscopy.When the stone diameter is 3cm-4cm,you can choose staged flexible ureteroscopy holmium laser lithotripsy or combined surgery After ESWL lithotripsy after assessment of risk.4.If the CT value of the stone is >800Hu and the diameter of the stone is >2cm.The percutaneous nephrolithotomy is better and the complications may be less.