标准通道与微通道经皮肾镜治疗合并肾内感染的肾结石的对比研究  

A comparative study of standard puncture passage percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy in treatment of renal calculi combined with renal intrarenal infection

作　　者：张林林[1] 朱李兵[1] 朱凌峰[1] 王栋[1] 杨涛[2] 谢星[1] 林若飞[1] 吴卫真[1] 

机构地区：[1]南京军区福州总医院泌尿外科 [2]福建医科大学公共卫生学院,福建福州350025

出　　处：《现代泌尿外科杂志》2011年第4期302-305,共4页Journal of Modern Urology

摘　　要：目的比较经皮肾镜标准通道与微通道碎石术在治疗合并肾内感染的肾结石的疗效和安全性。方法回顾分析2008年9月至2010年8月南京军区福州总医院246例应用经皮肾镜术治疗合并肾内感染的肾结石的患者资料。其中标准通道组132例,微通道组114例。对两组患者I期结石清除率、手术时间和手术并发症等指标进行比较分析。结果标准通道组与微通道组I期结石清除率分别为81.06%(107/132)和69.30%(79/114)(P<0.05),两组手术时间分别为(90±16)min和(110±15)min(P<0.05),术中灌洗液用量分别为(15 000±2 100)mL和(21 000±1 200)mL(P<0.05),术中出血量分别为(67.3±9.6)mL和(66.2±8.9)mL(P>0.05)。术中血细菌培养阳性两组分别为17例和28例(P<0.05)。两组术后发热分别为:低中热(T<38.5℃)分别为20例和21例,高热(T>40℃)分别为8例和14例(P<0.05),术后肾造瘘管引流液细菌培养阳性分别为28例和37例(P<0.05)。结论标准通道经皮肾镜术具有手术时间短、清石效率高、低压灌注及感染率低等优点,在处理合并肾内感染的肾结石病例上优于微通道经皮肾镜术。Objective To compare the efficacy and safety of standard puncture passage percutaneous nephrolithotomy （S-PCNL） and mini-percutaneous nephrolithotomy （M-PCNL） in the treatment of renal calculi combined with intrarenal infection. Methods Data of 246 patients with renal calculi combined with intrarenal infection treated during Sept. 2008 to Aug. 2010 were summarized and analyzed. S-PCNL was performed in 132 patients and M-PCNL in 114patients. Stone-free rate,operation time and complications were compared. Results In the S-PCNL and M-PCNL group respectively, the stone- free rate, the operation time, the amount of perfusion liquid, and the mean blood loss were 81.06% （107/132） and 69.30% （79/114） （P〈0. 05）, （90±16）min and （l10±15）min （P〈0.05）, （15 000±2 100）mL and （21 000±1 200）mL（P〈0.05）, and （67.3±9.6）mL and （66.2±8.9） （ P 〉0. 05） mL. Perioperative hemoculture found 17 patients in the SPCNL group and 28 patients in the M-PCNL group were positive （P〈0.05）. After the operation, in the S-PCNL group, 20 patients developed low and medium fever, while 8 patients high fever. In the M-PCNL group, 21 patients had low and medium fever while 14 high fever（P〉0. 05）. Culture of nephrostomy draining found 28 patients and 37 patients in the S-PCNL group and MI-PCNL group were positive（P〈0. 05） Conclusions S-PCNL has the advantage of shorter operation time,higher stone-free rate,lower pressure nerfusion and lower infection rate comnared with M-PCNL for renal calculi combined with intrarenal infection.

关 键 词：肾结石 经皮肾穿刺取石术 碎石术 

分 类 号：R692.4[医药卫生—泌尿科学]