微创经皮肾镜取石术治疗结石性脓肾的探讨(附21例报告)  

Treatment of Caculous Pyonephrosis with Minimally Invasive Percutaneous Nephrolithotomy(Report of 21 Cases)

作　　者：赵磊[1] 张忠云[1] 甘露[1] 段启林[1] 黄桂晓[1] 曾静[1] 黄树声[1] 李伟东[1] 

机构地区：[1]深圳市第五人民医院泌尿外科,深圳518001

出　　处：《临床泌尿外科杂志》2011年第3期177-179,共3页Journal of Clinical Urology

摘　　要：目的:探讨运用B超引导微创经皮肾镜取石术治疗结石性脓肾的疗效及安全性。方法:对21例结石性脓肾患者采用B超引导下微创经皮肾镜取石术进行治疗,钬激光碎石视情况决定一期或分期治疗,术中留置双J管,1个月后拔除。结果:16例一期取石治疗,5例二期取石治疗,手术过程顺利。1例术后出现感染性休克,及时治疗后好转,无其他严重并发症。结石全部清除或留有4 mm以下残余碎片者17例,肾残留碎石(大于5mm但不影响引流)4例,其中2例行ESWL后结石排出,2例未作特殊处理。随访4～32个月,20例患者肾功能有不同程度恢复,1例因患肾多发脓肿行患肾切除术。结论:B超引导微创经皮肾镜取石术治疗结石性脓肾安全有效,需视术中情况决定一期或分期治疗。Objective：To investigate the efficiency and safety of treating caculous pyonepnrosis with minimally invasive percutaneous nephrolithotorny（MPCNL）. Methods： 21 cases of caculous pyonephrosis were treated hy MPCNL with the guidance of uhrasound and the hohnium ： YAG laser. We decided one-stage or two-stage lithotripsy according to conditions in operation, and we placed D-J stent in ureter which was pulled out one month after operation. Results： 16 cases were treated in one-stage. 5 cases were treated in two-stage. All cases finished operation smoothly. One case met septic shock and was cured with prompt and proper treatment, no other severe complication occurred. 17 cases achieved stone-free or a state of residual stone smaller than 4 mm. 4 cases residual stones were larger than 5 mm which did not lead to collective system obstruction. Two of them passageed stones after ESWL and the other did not accept any other treatment. In followup of 4-32 months, the renal function of 20 cases improved which was showed by 1VU, the other case received nephrectomy because of muhifocal renal abscess. Cunclusions：MPCNl. is a safety and effective method treating caculous pyonephrosis and clinicians should consider patients＇condition to decide whether to perform one-or two-stage operation.

关 键 词：肾结石 脓肾 经皮肾镜取石术 

分 类 号：R692.4[医药卫生—泌尿科学]