| Background: Urinary calculi is the disease with the highest hospitalization rate in urology,and its incidence is increasing year by year.Once,the treatment of urinary calculi was based on surgery.But with the advancement of medical technology,the clinical treatment of urinary calculi has moved from traditional open surgery to minimally invasive,such as laparoscopic Lithotomy,extracorporeal shock wave lithotripsy,ureteroscope lithotripsy,flexible ureteroscope lithotripsy,percutaneous nephrolithotomy and other minimally invasive surgical methods.At present,domestic and foreign guidelines recommend PCNL as the first choice of treatment for renal calculi with a diameter of above 2 cm.However,PCNL has a high risk of bleeding,and can even be lifethreatening in severe cases,and its safety is low.FURL,as a small trauma and quick recovery method for the treatment of renal calculi,has been widely used in our country in recent years.FURL can be used to treat renal calculi with a diameter of less than 2 cm,and it has been recommended as a first-line treatment for the guidelines.However,for soft endoscopic treatment of calculi larger than 2 cm,there is controversy due to the low carrying energy of ordinary holmium laser fiber,low power,slow lithotripsy efficiency,long operation time,and high risk of postoperative complications.The 2016 Chinese expert consensus on flexible ureteroscopy has pointed out that flexible ureteroscopy can be used as an alternative treatment for renal calculi with a diameter above 2 cm.Therefore,experienced and skilled urologists can try to use flexible ureteroscope to treat calculi above 2 cm.Since 2019,our hospital has carried out hundreds of attempts to use FURL to treat renal calculi larger than 2 cm,and achieved good results.Objective:To compare the safety and effectiveness of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy in the treatment of 2-3 cm diameter renal calculi,and to further explore the advantages and disadvantages of the two treatments,so as to provide a basis for clinical decision-making.Methods: A prospective study was designed: the patients with renal calculi who were admitted to the Urology Department of our hospital from May 2020 to September 2021 were divided into a flexible endoscopy group and a nephroscopic group,respectively.FURL and PCNL were used to treat renal calculi.Among them,there were 40 patients in the flexible endoscopy group and 40 patients in the nephroscopy group.The patients in both groups were collected in chronological order and stopped after the group was completed.The flexible ureteroscope group was treated with FURL,and if the flexible ureteroscope failed to enter the operation during the operation,it was regarded as the operation failure.The nephroscopic group was treated with PCNL.If the intraoperative blood loss in the nephroscopic group was so large that the operative field was unclear,the operation was regarded as a failure.The operation time of both groups was less than 90 minutes.Two months after the operation,both groups underwent CT（Computer tomography）of the urinary system to check the stone clearance rate.The perioperative clinical data of the above patients were collected,and t test,χ2 test and rank sum test were used for statistical analysis of the data.By comparing the preoperative age,gender,body mass index（BMI）,calculi size,calculi location,calculi number,preoperative peripheral blood white blood cell count,and preoperative peripheral blood neutrophil ratio,statistical analysis showed that the two groups There was no significant statistical difference between the patients before operation,and then the success rate of operation,operation time,calculi clearance rate in 2 months after operation,postoperative hospital stay,postoperative complication rate,peripheral blood white blood cell count on the first day after operation,and operation rate were compared.The differences in the safety and efficacy of the two treatment methods were analyzed by the ratio of peripheral blood neutrophils and the changes of postoperative hemoglobin on the first day after surgery.Results: There was no significant difference in the age,gender,BMI,calculi size,calculi location,calculi number,preoperative peripheral blood white blood cell count,preoperative peripheral blood neutrophil ratio,peripheral blood white blood cell count on the first postoperative day and proportion of peripheral blood neutrophils on the first day after surgery（P>0.05）.And there was no significant difference in the success rate of surgery,operation time and calculi clearance rate in 2 months after operation（P>0.05）,but There were significant differences in postoperative hospital stay,postoperative complication rates and postoperative hemoglobin changes between the flexible endoscopy group and the nephroscopy group（P<0.05）.Conclusion: In the treatment of 2-3 cm renal calculi,flexible ureteroscopy and percutaneous nephrolithotomy are both safe and effective surgical methods.There is no significant difference between the two in calculi crushing efficiency and calculi removal rate.However,flexible ureteroscope lithotripsy has lower intraoperative blood loss,fewer postoperative complications and shorter postoperative hospital stay.It is recommended that experienced and skilled urologists choose flexible ureteroscope lithotripsy for the treatment of 2-3 cm renal calculi. |
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