经皮肾镜Ⅰ期治疗肾铸型结石合并脓肾45例  

Treatment of renal struvite staghorn calculi complicated with pyonephrosis via percutaneous nephrolithotomy

作　　者：周大庆[1] 王坚[1] 李文刚[1] 庞翔[1] 余小祥[1] 江波[1] 

机构地区：[1]解放军第303医院泌尿外科,南宁市530021

出　　处：《实用医学杂志》2011年第18期3326-3328,共3页The Journal of Practical Medicine

摘　　要：目的:探讨肾铸型结石合并脓肾的治疗方法。方法:分析合并脓肾的肾铸型结石患者45例,其中术前明确脓肾诊断27例,术中穿刺后发现脓肾18例,所有患者术前行常规尿培养,经抗感染治疗后行经皮肾镜治疗,术中穿刺成功后常规扩张至F24标准肾镜通道,根据结石坚硬程度分别用EMS超声或联合气压弹道碎石,手术时间控制在2h内,如结石无法清除,予留置肾造瘘管、双J管后再行二期手术治疗,术后根据情况行造瘘管间断呋喃西林冲洗。结果:术后复查,一期手术取尽结石32例(71%),8例仍有较多结石残留,行二期取石,5例残留结石较小,行体外冲击波碎石治疗后治愈。所有患者术后不同程度发热,17例体温超过38.5℃,常规行血培养,未见有菌血症或败血症。结论:标准通道经皮肾镜工作通道大,冲洗液容易流出,配合EMS超声碎石,肾盂内压力低,不易引起肾内逆行感染,可一期治疗合并脓肾的肾铸型结石。Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy tbr renal struvite staghon calculi complicated with pyonephrosis. Methods 45 patients who caught struvite staghon calculi complicated with pyonephrosis were analysised. Pyonephrosis was found in 27 patients pre-operation.18 patients were found complicated with pyonephrosis during operation.Urine culture were perfollned in all the patients before operation and percutanous nephrorithotomy were perfoumed after antibiotics treating. The tract was dilated to F24 and the stones were removed by EMS lithotrity system.The operation time were limited in two hours whenever the stone free or not. Results 32 patients were free-stone after first stage pereutaneous nephrorhhotomy and 8 patients were underwent second stage operation fore residual stones. 5 patients were cured by EWSL after first stsge operation. All the patients caught fever after operation and 17 patients＇ temperature were above 38.5℃ The blood culture were performed in all the patients.and bactermia and septicemia were not found. Conclusion Percutaneous nephrorithotomy of standard tract is a safe and effective procedure for struvite stahgorn eaeuli complicated with pyonephrosis.

关 键 词：肾积脓 经皮肾镜 铸型结石 

分 类 号：R699[医药卫生—泌尿科学]