| Objective: To investigate whether CT value of calculi can predict the efficiency and effect of mini percutaneous nephrolithotomy in the treatment of renal calculi,and analyze the risk factors that affect the stone removal rate of percutaneous nephrolithotomy,so as to provide the basis for urologists to make treatment plans in the face of different conditions.Methods: From December 2017 to December 2019,the clinical data of 124 adult patients who received MPCNL treatment in urology department of Affiliated Hospital of Hebei University of engineering were analyzed retrospectively,including76 male patients,48 female patients,54 left kidney stones,70 right kidney stones,12 upper calices stones,21 middle calices stones,8 lower calices stones,83 renal pelvis stones ? All the patients were scanned by 64 row spiral CT machine in our hospital.The surface area and average CT value of stones were calculated.According to the measured average CT HU,they were divided group A(CT value <1000HU)and group B(CT value?1000HU).Prophylactic antibiotics were used 30 minutes before operation,and holmium laser was used to crush the stones.The general situation,operation time,stone removal rate of single operation,hemoglobin decrease before and after operation,hospitalization time after operation and postoperative complications of the two groups were compared.At the same time,the factors that may affect the single mPCNL stone clearing rate are analyzed to find the risk factors that influence the single mPCNL stone clearing rate.Results: In this study,124 patients were included.The total stone removal rate was 83.06% and the total complication rate was 20.97%.There was no significant difference between the two groups in age,gender,stone location and stone surface area(P>0.05).In group A,the average operation time was(61.98±10.49)min,the average hemoglobin reduction before and after operation was(4.37±1.03)g / L,the average hospital stay after operation was(6.87±1.25)days,the incidence of postoperative complications was 8.33%(5/60),and the single stone removal rate was90%(54/60),among which 6 patients with residual stones were treated by ESWL.In group A,5 patients had postoperative complications,3 patients had significantly increased body temperature after operation,the blood routine examination showedthat the leukocyte count exceeded the normal value,and the patient's body temperature was gradually reduced to normal by upgrading antibiotics;2 patients had pain after operation,and the pain was relieved after the application of painkillers.In group B,the average operation time was(92.94±7.74)min,and the average hemoglobin decreased before and after operation was(10.23±2.17)g / L.there were 2patients with blood drainage tube after operation,and the flow was large.The blood routine examination showed that the hemoglobin decreased more than 20 g / L,and the symptoms improved after conservative treatment such as hemostatic drugs and clamping drainage tube;the average hospital stay after operation was(10.23±2.17)g /L.At 6.99±1.21 days,the single stone removal rate reached 76.56%(49/64).15 patients had residual stones on color Doppler or CT examination 4 days or 1 month after operation.One patient was treated with two-stage MPCNL,14 patients were treated with ESWL,and 15 patients were all treated with effective stone removal.In group B,18 patients had postoperative complications,the incidence of postoperative complications was 28.13%,in which 11 patients had temperature rise after operation,the blood routine examination showed that the leukocyte count was higher than the normal value,and the patient's temperature gradually turned to normal after the application of sensitive antibiotics according to the drug sensitivity results;5 patients had pain,and the pain was relieved after the application of painkillers.The rate of single debridement in group A(90.00%)was higher than that in group B(76.56%)(P<0.05).In group A,the mean postoperative hemoglobin reduction(4.37±1.03)g / L,the incidence of complications(8.33%)were lower than that in group B(10.23±2.17)g / L,and the incidence of complications(28.13%)(P<0.05).Spearman correlation analysis showed that there was a positive correlation between CT value and operation time,and the correlation coefficient was r = 0.834(P < 0.05).The results of logistic regression analysis showed that CT value and stone surface area were independent risk factors of stone residual after MPCNL.Conclusion:1.The calculi CT value can preliminarily predict the efficiency and effect of percutaneous nephrolithotomy.When the calculi CT value is less than1000 HU,the application of MPCNL can obtain shorter operation time and higher stone removal rate in the first stage and less complications;when the calculi CT value is more than 1000 HU,the MPCNL needs more second stage operations and more complications.At this time,we should optimize the operation plan to obtain higher complications in combination with the patient's condition Results.2.The stone surfacearea and CT value are independent risk factors for the rate of single stone removal. |
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