经皮肾镜双频双导管碎石系统一期治疗结石梗阻性脓肾37例临床观察  

Percutaneous nephroscopic dual probe ultrasonic intracorporeal lithotriptor in one-staged treatment of calculous pyonephrosis

作　　者：赖德辉[1] 李逊[1] 何永忠[1] 李天[1] 高伟[1] 徐桂彬[1] 杨炜青[1] 

机构地区：[1]广州医学院港湾医院泌尿外科,广东广州510700

出　　处：《海南医学》2010年第11期15-17,共3页Hainan Medical Journal

摘　　要：目的探讨经皮肾镜双导管碎石系统Ⅰ期治疗结石性脓肾的安全性和有效性。方法结石性脓肾37例,均在超声结合X线定位下引导穿刺,建立20F经皮肾通道,标准肾镜下采用CYBERWAND双导管碎石系统,先负压吸附清理脓液、脓苔和脓栓,再行超声碎石和清石。结果均在成功建立20F经皮通道,行Ⅰ期碎石,手术时间为35-107min,平均(70±11)min;处理结石时间13-50min,平均(37±9)min。本组未出现严重出血、气胸、肠道损伤等严重并发症。3例术后出现高热(T:39℃),细菌培养显示为阴沟肠杆菌,6例术后体温为38℃-39℃,其余病例术后体温<38℃,无脓毒败血症、感染性休克、肾周脓肿等严重并发症。术后1周复查KUB平片,32例患者结石取净,5例有结石残留,结石清除率为86.5%。结论经皮肾镜双导管碎石系统在处理结石性脓肾时,能在低压或者无压力状态下吸出脓液、脓栓后,无需依靠组织,悬空碎石,而且碎石和清石一并进行,治疗结石性脓肾安全,有效。Objective To investigate the efficacy and safety of percutaneous nephroscopic dual probe ultrasonic intracorporeal lithotriptor in one-staged treatment of calculous Pyonephrosis.Methods 37 cases with calculous pyonephrosis were punctured under ultrasound and X-ray guidance,and established a access of 20F.Dual probe ultrasonic intracorporeal lithotripter was used in suction of the liquor puris,and then to break and clear the calculi.Results The percutaneous renal access of 20F was successfully in all patients and immediate one-staged lithotripsy was performed.Average operative time was 70±11min,and average time for stone management was 37±9 min.There was no severe complications occurred,such as hemorrhage and pheumatothorax.3 cases suffered from fever over 39℃ and 6 cases with 38-39℃ after operation,and the other cases was below 38℃.No residual stone fragment in 32 cases,stone free rate was 86.5%.Conclusion Percutaneous nephroscopic dual probe ultrasonic intracorporeal lithotripter is highly efficient procedure and provides fast and safe stone removal in one-staged treatment of calculous pyonephrosis.

关 键 词：经皮肾镜 结石性脓肾 碎石术 

分 类 号：R691.4[医药卫生—泌尿科学]