Analysis Of Flexible Ureteroscopic Lithotripsy And Percutaneous Nephrolithotomy In The Treatment Of Kidney Stone Complicated With Infectious Shock

ObjectiveTo compare the efficacy of flexible ureteroscopic lithotripsy(FURL)and percutaneous nephrolithotomy(PCNL)in the treatment of kidney stone,and to explore the adaptation disease of the two operation method,meanwhile,analyze the reasons of infectious shock in the treatment of kidney stone.MethodsA total of 100 patients with kidney stone from December 2016 to December2017 in Affiliated Hospital of Jiangsu University were retrospective analyzed.The patients were divided into two groups,with 50 patients in each group.The patients in A group were received FURL treatment,while the patients in B group were received PCNL treatment.The positive of midstream urine bacterial culture,infection rate of urinary and the level of blood creatinine before operation,amount of bleeding,time of operation,transfusion,incidence rate of infectious shock,stone-free rates,the level of blood creatinine after operation 3 days,hemoglobin decrease average,length of stay for the two operation method were compared.Bacterial species of midstream urine for infectious shockpatients were analyzed.ResultsWhen the average stone volume was below 20 mm,the amount of bleeding with FURL treatment was lower than that with PCNL treatment,which showed significant difference based on t test(P<0.05).There was significant difference of operation time for the two groups on the basis of t test(P<0.05).The operation time of FURL group was longer than that of PCNL group.The stone-free rates of FURL treatment was higher than that of PCNL treatment,which showed significant difference based on chi-square test(P<0.05).There was no patient suffered from infectious shockwith FURL treatment,while the occurrence rate of infectious shock was 6.0% for patients with PCNL treatment.The occurrence rate of infectious shockshowed significantdifference based on chi-square test(P<0.05).There was no significant difference of the level of blood creatinine for the two groups when the average stone volume was below20mm(P>0.05).The hemoglobin decrease average as well as length of stay for patients with FURL treatment was lower than that with PCNL treatment,which showed significant difference based on t test(P<0.05).When the average stone volume was above 20 mm,the amount of bleeding with FURL treatment was lower than that with PCNL treatment,which showed significant difference(P<0.05).However,operation time as well as stone-free rates of PCNL treatment was lower than that of FURL treatment,which showed significant difference(P<0.05).There was no significant difference for occurrence rate of infectious shock as well as level of blood creatinine after operation of the two groups when the average stone volume was above 20mm(P > 0.05).The hemoglobin decrease average for patients with FURL treatment was lower than that with PCNL treatment,which showed significant difference based on t test(P<0.05).However,there was no significant difference for length of stay between the two groups(P>0.05).The midstream urine bacterial culture for patients of infectious shock was positive.Thenumber of escherichia coli was occupied 28.57%,the number of proteobacteria was occupied 14.29%,the number of enterobacter was occupied 14.29%,the number of pseudomonas was occupied 14.29%,the number of enterococcu was occupied 14.29%,the number of staphylococcus was occupied 14.29%.gram-negative bacterium was occupied 71.43%,while gram positive bacteria was occupied 28.57%.ConclusionWhen the average stone volume was below 20 mm,compared with PCNL,the amount of bleeding,occurrence rate of infectious shock,hemoglobin decrease average as well as length of stay for FURL treatment was lower,while stone-free rates and time of operation of FURL treatment was higher.Thus,FURL was recommended to thetreatment of stone volume below 20 mm.When the average stone volume was above20 mm,although the amount of bleeding as well as hemoglobin decrease average was lower,time of operation as well stone-free rates of FURL treatment was lower.Thus,PCNL rather than FURL was recommended to the treatment of stone volume above20 mm.There was close relationship between positive midstream urine bacterial culture and infectious shock.Gram-negative bacterium was the principal factor for infectious shock,while escherichia coli was the main bacterium in positive urine culture.