| Objective: To explore the possibility of FURL with intelligent pressure control replacing MPCNL as a routine treatment for > 2cm renal calculi by comparing the clinical effect and safety of IFURL and MPCNL in the treatment of > 2cm renal calculi.To evaluate the application value of Sha.Lin scoring system in IFURL.Methods: The clinical data of 74 patients with renal calculi larger than 2cm treated by IFURL or MPCNL in the Department of Urology,the First Affiliated Clinical Hospital of Jinan University from June 2020 to February 2021 were retrospectively analyzed,including IFURL group(n = 36)and MPCNL group(n = 38).The preoperative data(maximum diameter of stones,number of stones,location of stones,number of renal calyces involved,CT value of calculi and Sha.Lin score of calculi,etc.)of these patients were analyzed,and the operation time,changes of blood routine(white blood cells,red blood cells,hemoglobin,etc.)and renal function indexes(serum creatinine,urea nitrogen)before and after operation,hospitalization time,incidence of complications(According to Clavien-Dindo classification),stone clearance rate(within 1 week and 1 month after operation)and treatment effect were compared between two group.The complexity of calculi was evaluated by the Sha.Lin scoring system,and the application value of the Sha.Lin scoring system in the clinical treatment of IFURL was understood according to the correlation between the final stone clearance rate and the preoperative score.Results: There was no significant difference in preoperative data(age,gender,BMI,maximum diameter of stones,number of stones,difference of stone side,location of stones,number of renal calyces involved,CT value of stones,urinary tract infection,degree of hydronephrosis,liver function(ALT,AST),nutritional status(total protein,albumin)and Sha.Lin score)between the two groups(P > 0.05).The postoperative red blood cells and platelets in the two groups decreased compared with those before operation,but the difference was not statistically significant(P > 0.05);The degree of increase of white blood cells and decrease of hemoglobin in MPCNL group was significantly higher than that in IFURL group(4.95±5.04 vs 2.94±4.12,P=0.045;-7.01±8.1 vs-2.90±7.6,P=0.027);There was no significant difference in the changes of renal function indexes(serum creatinine and urea nitrogen)between the two groups(P > 0.05);the incidence of postoperative complications in MPCNL group was significantly higher than that in IFURL group(44.7% vs 11.11%,P=0.009),mainly manifested as more grade I complications in MPCNL group(31.6% vs11.11%,P=0.033).The incidence of postoperative pain,fever and vomiting in the MPCNL group was significantly higher than that in the IFURL group,but only the difference in the incidence of postoperative pain was statistically significant.In addition,the complications of grade II(Urinary tract infection needs other treatment or blood transfusion,etc.)and III(Interventional therapy,etc.)in MPCNL group were more than those in IFURL group(11.11 % vs 2.78%;2.78% vs 0),but the differences were not statistically significant(P > 0.05);The operation time in IFURL group was longer than that in MPCNL group(111.08±42.52 vs 107.58±46.68)minutes,the immediate stone clearance rate was lower than that in MPCNL group(61.1% vs 73.7%),and the final stone clearance rate was similar one month after operation(75% vs 81.6%);The IFURL group consumed less normal saline(3L)than the MPCNL group(3.06±1.22 VS 11.13±5.31,P < 0.001),the visual score of pain on the first day after surgery was significantly lower than that of the MPCNL group(2.94±1.09 vs 6.39±1.2,P < 0.001),and the hospitalization time was shorter than that of the MPCNL group(3.64±1.42 vs 5.74±2.37,P < 0.001).In this study,36 patients who received IFURL met the criteria of Sha.Lin score,and the Sha.Lin score of lithotripsy group was significantly lower than that of residual stone group(11.07±1.75 vs14.11±1.76 分,P<0.001),The AUC of ROC curve was0.889(95%CI 0.783-0.995,P<0.001),and the cut-off value of Youden index(sensitivity-1 + specificity)was 11.5.At this time,the positive rate(sensitivity)was66.7%,and the specificitywas 100%.Conclusion: 1.The two groups of surgical methods are safe and effective measures for the treatment of > 2cm renal calculi.2.The immediate stone clearance rate and final stone clearance rate of IFURL are similar to MPCNL,but IFURL is suitable for patients taking anticoagulants for a long time,and has the advantages of shorter postoperative hospital stay,lower pain score,less intraoperative blood loss and postoperative complications.3.The IFURL learning curve is greatly shortened,no need for intraoperative positioning equipment,fewer surgical assistants,the labor intensity is greatly reduced and the operation is safe,which is suitable for promotion in grass-roots units.4.The improved Sha.Lin score can also be used to predict the effect of IFURL with high accuracy and specificity. |
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