输尿管镜钬激光碎石术治疗合并急性肾感染的输尿管结石20例报告  

Ureteroscopic holmium laser lithotripsy in management of ureteral calculi associated with acute renal infection

作　　者：蔡维奇[1] 方先林[1] 董洁[1] 殷中玲[1] 张绍崎[1] 嵇福荣[1] 刘高[1] 

机构地区：[1]南京鼓楼医院集团宿迁市人民医院泌尿外科,江苏宿迁223800

出　　处：《现代泌尿外科杂志》2010年第1期38-40,共3页Journal of Modern Urology

摘　　要：目的探讨输尿管镜钬激光碎石治疗并发急性肾感染的输尿管结石的可行性和安全性。方法对20例并发急性肾感染的输尿管结石患者施行输尿管镜钬激光碎石术,将结石粉碎至3 mm以下。对合并输尿管息肉者,则将息肉切除。结果所有病例施行输尿管镜钬激光碎石术均1次将结石击碎,3例结石碎块较大上滑入肾盂,感染控制后辅以体外冲击波碎石清除结石残片。16例7 d内体温降至正常,腰痛症状消失。2例因肾积脓,双J管引流不畅,B超定位下行经皮肾穿刺引流而痊愈。1例肾周脓肿迁延不愈,取腰部竖直小切口切开引流而治愈。1例肾皮质脓肿辅以抗菌治疗,2周后复查病灶吸收。结论输尿管镜钬激光碎石急诊治疗并发急性肾感染的输尿管结石是一种安全有效的方法,能及时控制急性肾感染,防止重症肾感染的出现。Objective To evaluate the efficacy and safety of ureteroscopic lithotripsy with holmium laser for treatment of ureteral calculi associated with acute reanl infection. Methods The clinical data of 20 cases of ureteral calculi associated with acute renal infection were analyzed retrospectively. Ureteroscopic holmium lithotripsy was performed in all cases. The stones were fragmentated with holmium laser untill the size of fragments was less than 3mm. The ureteral polyp was incised if it coexisted with the calculi. Results All patients received ureteroscopic holmium laser lithotripsy with successful results. In 3 cases there were large fragments into pelves and residual fragments were cleared with ESWL after reanl recovery. The temperature and flunk pain for 16 cases diminished 1~7 days after surgery. In 2 patients with pyonephrosis and postoperative ureteral tract obstruction, percutaneous nephrostomy was performed, with ultrasound guidance and 16Fr silastic nephrostomy tube fixed in the tract, then temperature and flunk pain recovered. In one patient with perinephric abcesss, urgical drainage was performed through small incision in flunk. In one patient with reanl abcess antimicrobial therapy was selected and the patient recovered within 2 weeks. Conclusion Ureteroscopic holmium laser lithotripsy is a highly effective and safe therapy to prevent severe rena infection for patients with ureteral calculi associated with acute renal infection.

关 键 词：钬激光 输尿管结石 肾感染 碎石术 

分 类 号：R692.2[医药卫生—泌尿科学]