Comparative Study Of Combined Fluoroscopy And Simple Ultrasonography Percutaneous Nephrolithotomy

Objective : Compare the efficacy and safety of simple Ultrasonography and Ultrasonography combined with guided Fluoroscopy percutaneous nephrolithotomy for different S.T.O.N.E score renal stones.Methods:The clinical medical records of 322 patients with renal calculi who were admitted to the Department of Urology,the First Affiliated Hospital of Fujian Medical University from January 20 to December 2018,were collected.According to the simple Ultrasonography and Ultrasonography combined with guided Fluoroscopy percutaneous nephrolithotomy,divided into Ultrasonography and Ultrasonography combined with guided Fluoroscopy group.The two groups were divided into 5-7 group,8-10 group,and 11-13 group according to the S.T.O.N.E scoring system,and the same score group was compared between the two groups.The gender,age,renal stone S.T.O.N.E score,renal stone kidney distribution,establishment of percutaneous renal puncture channel,operation time,puncture target sputum,mean hemoglobin reduction before and after surgery,stage I stone free rate,postoperative the average hospitalization time and the overall incidence of postoperative complications were statistically analyzed.Results: A total of 322 patients,154 patients with simple Ultrasonography group,including 77 patients with STONE score of 5-7,56 patients with 8-10,21 patients with 11-13,and 168 patients with Ultrasonography combined with guided Fluoroscopy,including The STONE score was 5-7 in 69 cases,8-10 in 77 cases,and 11-13 in 22 cases.There were no statistical differences in preoperative general data,such as gender,age,stone S.T.O.N.E score,and renal stone kidney distribution between the same scoring group.There was no significant difference in the number of percutaneous renal puncture channels,the target of puncture,the average operation time,the average length of hospital stay,and the overall complication rate between the Ultrasonography and Ultrasonography combined with guided Fluoroscopy group in the same scoring group.The hemoglobin reduction after surgery between the Ultrasonography and Ultrasonography combined with guided Fluoroscopy group in the S.T.O.N.E score between 5-7 grouping was 14.74±7.05g/L and 15.39±9.75g/L(P=0.648),and the postoperative stage I stone free rate was 88.3%(68/77cases).92.8%(64/69cases)(P=0.363),no statistical difference.The hemoglobin reduction after surgery between the Ultrasonography and Ultrasonography combined with guided Fluoroscopy group in the S.T.O.N.E score between 8-10 grouping was 19.9±8.4g/L and 15.5±9.5g/L(P=0.006),the postoperative stage I stone free rate was 67.9%(38/56cases)and 83.1%(64/77cases).(P=0.04),there was a statistical difference.The Ultrasonography combined with guided Fluoroscopy group had lower hemoglobin reduction after surgery than the simple Ultrasonography group,and the postoperative stage I stone free rate was higher than the simple Ultrasonography group.The hemoglobin reduction after surgery between the Ultrasonography and Ultrasonography combined with guided Fluoroscopy group in the S.T.O.N.E score between 11-13 grouping was 28.7±6.4g/L and 21.9±12.1g/L(P=0.026),the postoperative stage I stone free rate was 47.6%(10/21cases)and 77.2%(17/22cases).(P=0.044),there was a statistical difference.The Ultrasonography combined with guided Fluoroscopy group had lower hemoglobin reduction after surgery than the simple Ultrasonography group,and the postoperative stage I stone free was higher than the simple Ultrasonography group.The Ultrasonography combined with guided Fluoroscopy group STONE score 5-7 group,8-10 group,11-13 group surgery,X-ray exposure time was 9.1 ± 36.5s,12.7 ± 48.9s,38.9 ± 64.0s,patients were 16.1 ± 44.7s,21.9 ± 59.5s,and 67 ± 103.2s,respectively.The Xray exposure time of the simple Ultrasonography group was 0.Conclusion: With the increase of S.T.O.N.E.score,Ultrasonography combined with guided Fluoroscopy can achieve higher stage I stone free rate and lower intraoperative blood loss than PCNL guided by simple Ultrasonography.There was no significant difference in the overall postoperative complication rate between simple Ultrasonography and Ultrasonography combined with guided Fluoroscopy PCNL.