| Background and Objective:Upper urinary tract calculi is the most common type of urinary calculi and it needs to be treated by surgery when it leads to obstruction,infections,renal injury,etc.Percutaneous nephrolithotomy is a common method for treating patients with upper urinary tract stones.However,the selection of puncture positioning is a key factor in percutaneous nephrolithotomy,which is also a focus that urologists have been concerned about all the time.Currently,puncture positioning methods are various in the clinic,including B-ultrasound puncture positioning,X-ray puncture positioning,B-ultrasound combined with X-ray puncture positioning,CT puncture positioning,fiberendoscopic direct vision puncture positioning,robot-assisted puncture positioning and so on.Nevertheless,B-ultrasound combined with X-ray puncture positioning has been the most widely applied in percutaneous nephrolithotomy at present.In the early stage,X-ray puncture positioning was the most important method in percutaneous nephrolithotomy.Due to the radiation of X-ray,many doctors were reluctant to use it,so in recent years,doctors are increasingly intended to use B-ultrasound to complete puncture positioning.As we all know,there are few reports on the safety and efficacy of single-tract percutaneous nephrolithotomy with B-ultrasound puncture positioning in China.Therefore,we collected and analyzed the clinical data of patients with upper urinary tract stones who were treated by using B-ultrasound puncture positioning to carry out percutaneous nephrolithotomy which was performed by the same senior doctor with rich experience in percutaneous nephrolithotomy,and observed the effect of the surgical treatment to explore its clinical application value.Methods:We collected clinical data from 227 patients with renal and ureteral stones who underwent ultrasound-guided percutaneous nephrolithotomy which was performed by the same senior doctor with rich experience in percutaneous nephrolithotomy in the Department of Urology at the First Affiliated Hospital of Guangzhou Medical University between October 2019 and August 2021.The data included gender,age,BMI,underlying diseases,history of kidney surgery,stone location,size,shape distribution,CT value,degree of hydronephrosis,S.T.O.N.E.Score,and preoperative urinary tract infection conditions.Based on the S.T.O.N.E.score,patients were divided into two groups: group 1(5-8 scores)and group 2(9-12 scores).Two groups had similar sample size and were comparable.We analyzed the data to determine the postoperative stone-free rate,operation time,intraoperative blood loss,postoperative hospital stay,retreatment of residual stones,and complications.The measurement data were presented as mean ± standard deviation,with results rounded to two decimal places.Results:In this study,all 227 patients successfully received the puncture and established the percutaneous access through B-ultrasound guidance,and the puncture success rate was100%.All patients’ stones were found and crushed.The mean operative time was(73.11 ±24.10)minutes(range,20-160 minutes).The mean blood loss was(16.37 ± 20.43)ml,(range,0 to 200 ml).No intraoperative blood transfusions were necessary.The postoperative hospital stay ranged from 1 to 39 days,except for one case of perirenal hematoma,infection,and blood transfusion treatment due to renal artery bleeding,which required a hospital stay of 39 days.The remaining patients had a hospital stay ranging from 1 to 15 days,with an average of(3.03 ± 3.44)days.The stone-free rate was evaluated within 4 weeks after the operation.Out of the total of 227 cases,149 had cleared calculi and 78 still had residual stones.The overall first-stage stone-free rate was 65.6%.Within 6 months after the operation,23 out of the 78 cases(29.49%)with residual stones underwent reoperation.Comparing these two groups,the stone-free rate in patients with S.T.O.N.E.scores of 5-8 was 85.48%,with an mean operative time of(64.01 ± 17.13)minutes,and a residual stone retreatment rate of 5.13%.For patients with S.T.O.N.E.scores of 9-12,the stone-free rate was 41.75%,the mean operative time was(84.06 ±26.68)minutes.The stone free rate and operation time were both significantly different(p< 0.05)between the two groups.The stone clearance rate was low in the Group which S.T.O.N.E score was 9～12 score,and the residual stone retreatment rate was 24.36%.There were 16 patients underwent percutaneous nephrolithotripsy by B-ultrasound guidance again within 3 months after operation and 8 patients still had postoperative residual stones after a second operative procedure.The stone clearance rate was 50%(8/16)after the second ercutaneous nephrolithotomy.Among the patients with residual stones after the second percutaneous nephrolithotomy,2 patients underwent the third percutaneous nephrolithotomy by ultrasound guidance,of which 1 patient had residual stones after surgery,and the other one had complete residual stone removal.The stone clearance rate after the third percutaneous nephrolithotomy was 50%(1/2).Conclusion:Single-tract percutaneous nephrolithotomy by ultrasound guidance is a safe and reliable treatment option for patients with renal and ureteral stones with S.T.O.N.E.scores≤8.However,with increasing S.T.O.N.E.score,the stone-free rate decreases,and the operative time becomes longer,resulting in a reduced therapeutic effects.Despite this,ultrasound-guided puncture positioning provides a radiation-free option for both surgeons and patients,with a low complication rate and high safety.Therefore,for patients with upper tract urinary stones(S.T.O.N.E.scores ≤ 8),ultrasound-guided percutaneous nephrolithotomy is a preferred treatment option. |
PDF Full Text Request