Clinical study of MPCNL combined with lateral positional Y-type negative pressure suction sheath for staghorn calculi in middle-aged and elderly patients

doi:10.3877/cma.j.issn.1674-3253.2023.02.009

Abstract

Abstract:

Objective

To analyze the effect of minimally invasive percutaneous nephro-lithotripsy (MPCNL) combined with Y-type negative pressure suction sheath in the lateral decubitus position in the treatment of middle-aged and elderly patients with kidney-cast stones.

Methods

From May 2018 to December 2019, 96 middle-aged and elderly patients (aged between 55 and 70 years old) with unilateral renal cast stones were admitted to Foshan Traditional Chinese Medicine Hospital. According to the operation way, they were divided into an observation group (n=49) and a control group (n=47). The control group was treated with MPCNL in lateral position, and the observation group was treated with mPCNL and Y-type negative pressure sheath suction also in lateral position. The perioperative indices (hospital stay, blood loss, change of blood creatinine, and operation time), postoperative complications, and clearance rate of the two groups were compared.

Results

The stone removal rate of the observation group was higher than that of the control group, the operation time was shorter than that of the control group, and the blood loss was less than that of the control group, the differences were statistically significant (P<0.05), there were no significant differences in the total incidence of complications in the two groups (P>0.05).

Conclusion

mPCNL combined with negative pressure suction in lateral position can improve the safety and effect of operation of kidney casting stones in middle-aged and elderly patients.

Key words: PCNL, Holmium laser, Negative pressure attraction, Kidney stones

Jingmiao Jin, Wei Wei, Yuxiang Zhong, Yuan Mai, Jianhua Huang, Pengpeng Zhao, Fuxiang Lin, Kuangyi Li, Zhanping Xu. Clinical study of MPCNL combined with lateral positional Y-type negative pressure suction sheath for staghorn calculi in middle-aged and elderly patients[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(02): 144-148.

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URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2023.02.009

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References 16

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组别	例数	年龄[岁，(±s)]	性别（例）		结石大小[mm，(±s)]	积水程度（例）			结石侧别（例）
组别	例数	年龄[岁，(±s)]	男	女	结石大小[mm，(±s)]	无	轻	重	左	右
对照组	47	63±4	24	23	41±11	14	19	14	18	29
观察组	49	63±4	25	24	42±11	16	20	13	19	30
统计值		t=-1.069	χ²=0.000		t=0.305	Z=0.084			χ²=0.002
P值		0.288	0.997		0.761	0.886			0.962
组别	合并疾病（例）						体质量指数[kg/m²，(±s)]	术前血肌酐[μmol/L，(±s)]	术中发现脓肾(例)
组别	高血压	冠心病	糖尿病	慢性阻塞性肺疾病	脑梗塞	合并2种及以上疾病	体质量指数[kg/m²，(±s)]	术前血肌酐[μmol/L，(±s)]	术中发现脓肾(例)
对照组	21	8	9	6	5	8	24.9±3.0	108±20	6
观察组	23	10	11	7	4	7	24.7±3.3	111±12	5
统计值	χ²=0.049	χ²=0.181	χ²=0.158	χ²=0.040	χ²=0.173	χ²=0.136	t=-0.240	t=0.764	χ²=0.155
P值	0.824	0.671	0.691	0.841	0.677	0.712	0.811	0.447	0.694

组别	例数	年龄[岁，(±s)]	性别（例）		结石大小[mm，(±s)]	积水程度（例）			结石侧别（例）
组别	例数	年龄[岁，(±s)]	男	女	结石大小[mm，(±s)]	无	轻	重	左	右
对照组	47	63±4	24	23	41±11	14	19	14	18	29
观察组	49	63±4	25	24	42±11	16	20	13	19	30
统计值		t=-1.069	χ²=0.000		t=0.305	Z=0.084			χ²=0.002
P值		0.288	0.997		0.761	0.886			0.962
组别	合并疾病（例）						体质量指数[kg/m²，(±s)]	术前血肌酐[μmol/L，(±s)]	术中发现脓肾(例)
组别	高血压	冠心病	糖尿病	慢性阻塞性肺疾病	脑梗塞	合并2种及以上疾病	体质量指数[kg/m²，(±s)]	术前血肌酐[μmol/L，(±s)]	术中发现脓肾(例)
对照组	21	8	9	6	5	8	24.9±3.0	108±20	6
观察组	23	10	11	7	4	7	24.7±3.3	111±12	5
统计值	χ²=0.049	χ²=0.181	χ²=0.158	χ²=0.040	χ²=0.173	χ²=0.136	t=-0.240	t=0.764	χ²=0.155
P值	0.824	0.671	0.691	0.841	0.677	0.712	0.811	0.447	0.694

组别	例数	手术时间[min，(±s)]	住院时间[d，(±s)]	术后血红蛋白下降值[g/L，(±s)]	术后血肌酐[μmol/L，(±s)]	结石清除率(%)
对照组	47	82±10	8.2±2.6	19±7	115±16	76.60(36/47)
观察组	49	70±8	7.9±2.4	12±4	117±11	91.84(45/49)
统计值		t=-6.527	t=-0.535	t=-6.347	t=0.548	χ²=4.227
P值		<0.001	0.594	<0.001	0.585	0.040

组别	例数	手术时间[min，(±s)]	住院时间[d，(±s)]	术后血红蛋白下降值[g/L，(±s)]	术后血肌酐[μmol/L，(±s)]	结石清除率(%)
对照组	47	82±10	8.2±2.6	19±7	115±16	76.60(36/47)
观察组	49	70±8	7.9±2.4	12±4	117±11	91.84(45/49)
统计值		t=-6.527	t=-0.535	t=-6.347	t=0.548	χ²=4.227
P值		<0.001	0.594	<0.001	0.585	0.040

组别	出血	发热	感染性休克	2种以上并发症
对照组	5	9	2	4
观察组	3	6	0	3
χ²值	0.640	0.867	-	0.202
P值	0.424	0.352	0.144	0.653

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