摘要
目的探讨微创经皮肾镜取石术联合负压装置一期治疗结石性脓肾的有效性和安全性。方法回顾性分析2008年6月至2011年6月应用微创经皮肾镜取石术治疗的83例结石性脓肾患者的临床资料，其中输尿管上段结石15例、肾盂结石9例、多发性肾结石28例、铸型肾结石31例，结石直径1．2～6．3cm，均有肾盂出口梗阻。术中c臂x线机或B超引导行经皮肾穿剌。患者经皮肾穿刺时均抽出脓性尿液，应用筋膜扩张器一步扩张建立20F工作通道，12F李氏微创肾镜连接负压装置，先吸出肾内脓液，行一期碎石取石，术中通过间歇性负压吸引保持肾内低压。结果83例均成功建立20F通道并一期碎石取石，手术时间（34±19）min。24例输尿管上段结石及肾盂结石均一期取净结石；59例多发。肾结石及铸型结石患者结石一期取净33例，结石残留26例，行二期取石术。一期结石总清除率为68．7％（57／83），二期结石清除率为91．6％（76／83）。术后发热7例，血培养未见致病菌生长，经对症抗炎治疗1～3d后体温恢复正常，未发生败血症或感染性休克等并发症。结论微创经皮肾镜取石术中，20F单通道联合负压装置一期治疗结石性脓肾安全、有效。
Objective To evaluate the efficacy and safety of minimally invasive percutaneous neph- rolithotomy combined with negative pressure system in one-stage treatment of calculus pyonephrosis. Methods Eighty-three cases of calculus pyonephrosis, including 15 upper ureteral calculus cases, 9 renal pelvis calculus cases, 28 multiple calculus cases and 31 staghorn calculus cases, were retrospectively ana- lysed. The diameter of the stone was from 1.2 to 6.3 cm. All the patients were punctured under X-ray or ul- trasound guidance and established an access of 20 F. A 12 F nephroscope, combined with negative pressure system, was inserted to the collecting system to suck off the liquor pus. The stone was fragmented by pneu- matic lithotripsy or holmium laser lithotripsy at one-stage. Negative pressure system was used to reduce the intrapelvic pressure during the operation. Results All the patients were treated successfully. The average operative time was 34 ＋ 19 min. The upper ureteral calculus and renal pelvis calculus cases were all stone- free at one-stage treatment. Of the other 59 cases, 33 cases were stone-free and 26 cases need a second- look. The total stone free rate was 68.7% （57/83） at one-stage and 91.6% （76/83） at second-look. Only 7 patients had fever after operation and no patient had sepsis or shock. Conclusion Combined with nega- tive pressure system, minimally invasive percutaneous nephrolithotomy via a 20 F tract is safe and effective for one-stage treatment of calculus pyonephrosis.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2013年第2期93-95,共3页
Chinese Journal of Urology
关键词
尿路结石
脓肾
肾造口术
经皮
治疗结果
Urinary calculi
Pyonephrosis
Nephrostomy, percutaneous
Treatment outcome
