The Safety Analysis Of Percutaneous Renal Access Was Established By Ultrasound-guided And Ureteroscopic Two-step Dilatation

Objective: To study the safety and feasibility of establishing the kidney tract by two-step dilation combination with ureteroscope under ultrasound guidance.Methods: A total of 240 cases of micro-channel Percutaneous nephrolithotomy(MPCNL,mini-percutaneous litholithotomy)were studied in the first affiliated hospital of nanchang university from June 2018 to June 2019.According to the admission sequence number,the even number was recorded as the expermental group,and the odd number was recorded as the control group.According to the principle of random allocation,the patients were divided into the control group and the expermental group,each group of 120 cases,patients in the control group were treated with MPCNL by two-step dilation under ultrasound guided puncture to establish the kidney tract.patients in the expermental group were treated with MPCNL by two-step dilation combination with urteroscopy under ultrasound guided puncture to establish the kidney tract.record the comparison of two groups of patients with one-time success rate of percutaneous renal channel to establish,stone free rate,tubeness rate,average haemoglobin decline after operation,postoperative bleeding blood transfusion rate,average percutaneous renal channel set up time,average operation time,etc.Furthermore,the safety and feasibility of establishing the percutaneous renal passage under ultrasound guidance and ureteroscopy were analyzed.Results: all the 240 patients were treated with MPCNL in the first stage.In the expermental group,the success rate of one-time channel establishment was 99.2%(119/120)higher than that of the control group(90.0%(108/120),and the difference was statistically significant(p<0.05).The stone free rate of the expermental group was91.7% compared with 83.3% of the control group,and the difference was not statistically significant(P>0.05).The tubeness rate of the expermental group was100% compared with 83.3% of the control group,and the difference was statistically significant(P<0.05).The average postoperative decrease of hemoglobin in the control group was 14.48±2.242(11-20)g/L compared with the expermental group,which was10.52±1.426(9-13)g/L.The difference was statistically significant(P<0.05).The postoperative blood transfusion rate of the expermental group was significantly lowerthan that of the control group by 5%(6/120),and the difference was statistically significant(P<0.05).The mean percutaneous renal channel establishment time of the two groups was calculated that The control group was 5.22±1.304(3-10)min higher than the expermental group 5.08±0.747(4-6)min and the difference was not statistically significant(P>0.05).The mean operation time of the expermental group was 69.70±13.60(50-98)min,which was lower than that of the control group(91.68±9.06(60-110)min),and the difference was statistically significant(p<0.05).Conclusion: the method of establishing the percutaneous renal passage with ultrasound guidance and two-step dilatation under ureteroscope is accurate and reliable,with high success rate of passage establishment,less intraoperative blood loss and low postoperative bleeding and transfusion rate,which can significantly improve the safety of surgery.