| Objectives:This study aims to investigate the safety and efficacy of 18F negative pressure nephrolithotomy in microchannel percutaneous nephrolithotomy for 2-4cm kidney stones.Methods:30 in-hospital patients with 2-4 cm kidney stones during February 2021-July 2022 in the second affiliated hospital of Kunming Medical University were included in this study.All the treatments were approved by the ethics committee of the hospital.All the patients were informed and agreed with the treatments.By random grouping,15 patients were treated with 18F negative pressure lithotriptic stone removal,while the other 15 patients were treated with 18F ordinary Peel-Away sheath lithotriptic stone removal.The following physiological indexes were recorded and conpared between groups:intraoperative renal intrapelvic pressure,operation time,hemoglobin(before and after operation),volume of removed gravel,stone free rate,incidence of complications and length of hospital stay.Results:MPCNL surgery was successfully performed on all patients.The mean intrapelvic pressure,maximum intrapelvic pressure,minimum intrapelvic pressure,the times of highest intrapelvic pressure≥30 mm Hg and the duration of the highest intrapelvic pressure≥30 mm Hg in the experimental group were all lower than those in the control group.The average intrapelvic pressure between the experimental group and the control group was(13.04±7.84 mm Hg)vs(19.40±7.80 mm Hg),and the highest intrapelvic pressure was(37.53±9.46 mm Hg)vs(58.87±22.49mm Hg).The lowest intrapelvic pressure was(4.20±7.93 mm Hg)vs(11.93±5.98mm Hg).The times of highest intrapelvic pressure≥30 mm Hg was 2(0,11)times vs9(4,46)times.The duration of the highest intrapelvic pressure≥30 mm Hg was12(0,203 s vs 64(41,576)s with p value<0.05,and the differences were statistically significant.The stone free rate was 14/15 in the experimental group and 8/15 in the control group with p value<0.05,and the difference was statistically significant.No postoperative fever,pneumothorax,pleural and abdominal effusion,perrenal abscess,renal rupture,massive bleeding,and the need for blood transfusion were occurred in both groups.Hemoglobin:Pre-operative hemoglobin of experimental group and control group was(146.80±11.40 g/L)vs(146.40±16.52 g/L),while post-operative hemoglobin of experimental group and control group was(128.80±16.09 g/L)vs(131.47±16.15 g/L).The differences between pre-and post-operation in each group were statistically significant(p value<0.05),but there was no significant difference between groups(p value>0.05).Infection indicators:The enrolled patients were patients without infection or infection had been actively and effectively controlled,and there was no statistical significance in the changes of infection indicators of procalcitonin(PCT)before and after surgery between the two groups(p value>0.05).The mean operation time of the experimental group was 1614(431,2793)s and1324(592,1793)s in the control group.The difference was not statistically significant(p value>0.05);Inhospital time:The experimental group 8(6,10)days vs the control group 6(5,9)days,which showed no significant difference(p value>0.05).The volume of gravel removed during operation for the experimental group and the control group was 4000(2000,5000)mm~3vs 2000(1000,2000)mm~3(p value<0.05),and the difference was statistically significant.Conclusions:In this MPCNL control study of 2-4 cm kidney stone removal by the negative pressure clear stone sheath group and peel-Away sheath group,it was found that the average intrapelitoneal pressure,the highest intrapelitoneal pressure,the lowest intrapelitoneal pressure,the times of highest intrapelvic pressure≥30mm Hg and the duration of the highest intrapelvic pressure≥30 mm Hg were all lower than those in the control group.The negative pressure sheath showed certain advantages in MPCNL in reducing the intrapelitoneal pressure,and there was statistical significance in the intrapelitoneal pressure between the two groups.The stone free rate of the negative pressure sheath clearing group was higher than that of the control group,and the difference between the two groups was statistically significant.There was no difference in complication rate,operation time and hospital stay between the two groups.The volume of gravel removed in the negative pressure sheath group was larger than that in the control group,which suggetsts that the negative pressure sheath shows certain advantages in the recovery efficiency of gravel. |
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