Efficacy And Safety Of Percutaneous Nephrolithotripsy In The Treatment Of Upper Urinary Tract Stones Combined With Renal Insufficiency

Objective:To evaluate the curative effect and complications of percutaneous nephrolithotripsy(PCNL)in patients with upper urinary tract stones and renal insufficiencyMethods:Collect relevant clinical data of 88 patients who underwent percutaneous nephroscope holmium laser lithotripsy in patients with upper urinary tract stones and renal insufficiency from July 2017 to July 2019 in the urology department of Hospital.Before operation,routine examinations of blood routine,renal function,CT,urine analysis and urine bacterial culture were performed.Empirical use of antibacterial drugs or selection of sensitive drugs based on urine culture results was used to treat urinary tract infections.The patients' hemoglobin,BUN,creatinine and eGFR before and after 1 day of the operation,and postop erative hospital stay,stone clearance rate and postoperative complications were recorded to campare the clinical differences.The recurrence of blood creatinine,eGFR and calculi were followed up at 1 month,3 months and 6 months after operation,and the postoperative efficacy was comparedResult 1.Of the 88 patients in this study,50 were male and 38 were female,with an average age of 58.65±10.67 years.There were 24 patients with history of hypertension,12 patients with history of diabetes,and 49 patients with previous history of surgery.There were 10 cases of staghorn stones,3 cases of partial staghorn stones,and 29 cases of multiple kidney stones.The average diameter of stones before surgery was 33.22±15.85mm,There were 26 cases with mild hydronephrosis,25 cases with moderate hydronephrosis,and 37 cases with severe hydronephrosis.The average thickness of renal parenchyma is 12.8mm.Postoperative stone removal rate was 65.9%(58/88).The postoperative hospital stay was 5.86±1.78 days.88 patients establis hed 18F renal puncture channels,all successfully completed lithotripsy,and hemoglobin,BUN,blood SCr and eGFR before and after surgery were statistically significant(P<0.05)2.The occurrence rate of complications was 14.8%(13/88),the occurrence rate of ? level complication was 8.0%(7/88).Among which,7 cases of the post-op fever(38.5?-40.0?);? level complication took up 5.7%(5/88),of which,one case of systemic inflammatory response syndrome(RIRS),4 cases of blood transfusion due to post-op hemo rrhage;0 case of ? level complication.The occurrence rate of ? level complication was 1.1%(1/88),thereinto,one case of post-op multiple organ failure;0 case of V level complication.3.In this subject,51 cases of CKD3,including 25 males and 26 females;aged 21-84 years,with an average age of 59.18±11.50 years.The average diameter of stones was 33.90±17.77mm;stone removal rate was 64.7%;postoperative hospital stay was 5.50±1.22 days.The pre-operation and post-operation comparison,creatinine and eGFR rose on the first post-operation day than the value in the pre-operation test,yet the differences had no statistical significance(P>0.05);the value of post-op hemoglobin and BUN had apparent decline than the value in the pre-operation test,the differences were statistically significant(P<0.05)CKD 4-5 stage included 25 males and 12 females,aged 36-77 years,with an average age of 57.92±9.28 years;Stone diameter was 32.27±12.90mm.The stone removal rate was 67.6%;the postoperative hospital stay was 5.40±0.60 days.There was a statistically significant difference in the hemoglobin?BUN?creatinine change range and eGFR change range in the CKD4-5(P<0.05).4.One month after operation,among the 88 patients,0 cases lost follow-up and 88 cases were followed up successfully.Among the 88 patients,there was no stone recurrence,14 patients' renal function improved,64 patients' renal function was stable,and 10 patients' renal function deteriorated after operation.Three months after operation,among the 88 patients,21 cases lost follow-up and 67 cases were followed up successfully.Among the 67 patients,there was no stone recurrence,11 patients' renal function improved,48 patients' renal function was stable,and 8 patients' renal function deteriorated after operation.Six months after operation,among the 88 patients,47 cases lost follow-up and 41 cases were followed up successfully.Among the 41 patients,there was no stone recurrence in 35 cases,stone recurrence in 6 cases,improvement of renal function in 8 cases,stable renal function in 27 cases and deterioration of renal function in 6 cases.Conclusions:1.Percutaneous nephrolithotripsy can improve the renal function of patients with renal insufficiency calculi,with less complications,high stone removal rate,and controllable surgical risk.2 Renal insufficiency(CKD4-5 stage)patients have significantly improved renal function after operation.3.Patients with upper urinary tract stones combined with renal insufficiency have a high risk of surgery.It is necessary to accurately assess the condition before surgery,master intraoperative skills,and handle complications in a timely manner after surgery.