Clinical Study Of Tubeless Microchannel Percutaneous Nephrolithotomy In The Treatment Of Upper Urinary Tract Calculi

Objective: To explore the safety and efficacy of tubeless microchannel percutaneous nephrolithotomy in the treatment of upper urinary tract calculi.Methods: From January 2019 to June 2020,85 patients with upper urinary tract calculi who were admitted to the department of urology and underwent microchannel percutaneous nephrolithotomy(m PCNL)were selected as the study objects.The preoperative examinations of the patients all met the entry criteria and were randomly divided into two groups: the tubeless m PCNL group;the standard m PCNL group.Among them,43 cases were in the tubeless group and 42 cases were in the standard group.Record and analyze the two groups of patients(1)preoperative general clinical data: age,gender,BMI,underlying disease,operative side,degree of renal hydrops,stone location,number of stones,maximum diameter of stones,and positive rate of urine culture.(2)Surgery time,postoperative hospital stay,hospitalization expenses and related indicators of blood tests before and after surgery.(3)Postoperative pain,complications,and stone free rate.Results: Through comparison,the general clinical data of the two groups of patients,such as age,gender,BMI,underlying disease,operative side,degree of renal hydrops,stone location,number of stones,maximum diameter of stones,and positive rate of urine culture are comparable(P>0.05).There were no statistically significant differences in operation time,postoperative hemoglobin change,postoperative white blood cell change,postoperative albumin change,postoperative creatinine change,complications,and stone free rate between the tubeless group and the standard group(P>0.05).The postoperative hospital stay was 3.70±0.67 days in the tubeless group and 5.31±0.68 days in the standard group.In terms of hospitalization costs,the tubeless group was 20549.17±1963.66 yuan and the standard group was 21808.63±2559.46 yuan,both P<0.05.The difference is statistically significant.The pain scores of the tubeless group and the standard group were 3.49±0.51vs4.98±0.68 on the first postoperative day(P<0.05),and the pain scores on the second day after surgery were 2.37±0.49vs3.52±0.51(P<0.05),the pain scores on the third day after surgery were 1.49±0.55 vs 2.90±0.53(P<0.05).Among them,8patients in the tubeless group used analgesics after surgery,and 17 patients in the standard group used analgesics after surgery,P=0.027,the difference is statistically significant,and the frequency of the use of analgesics in the standard group is higher than that in the tubeless group.Conclusion: The tubeless m PCNL is a safe and effective surgical procedure for the treatment of selected patients with upper urinary tract calculi.Compared with standard m PCNL,it has the advantages of reducing postoperative pain,shortening the length of hospitalization,and reducing hospitalization costs.