经皮肾镜取石术联合负压吸引法选择性一期治疗结石性脓肾  

Treatment of selective calculus pyonephrosis with minimally invasive percutaneous nephrolithotomy combined with negative pessure equipment at one-stage

作　　者：刘峦松[1] 王民增 

机构地区：[1]玉田县医院泌尿外科,河北玉田064100

出　　处：《西部医学》2014年第2期216-218,共3页Medical Journal of West China

摘　　要：目的探讨微创经皮肾镜取石术(MPCNL)中联合负压吸引法选择性一期治疗结石性脓肾的安全性及疗效。方法 2009年1月~2013年4月,应用MPCNL选择性治疗结石性脓肾27例,其中输尿管上段结石7例(包括1例合并肾盂结石),单发肾盂结石9例,多发肾结石11例,结石大小1.2cm×0.7cm^2.5cm×1.8cm。穿刺时均有脓性尿液,建立18F经皮通道,使用12F肾镜连接负压吸引器,先吸净脓尿,再行一期碎石取石。术中保持冲洗液低压灌注。结果手术时间(38±16)min,7例输尿管上段结石均一期取净,9例单发肾盂结石一期取净8例,11例多发肾结石一期取净7例。结石残留5例,行二期取石。一期结石总清除率为81.4%(22/27例)。术后发热25例,经抗炎对症处理1~4天后体温恢复正常,未发生败血症及感染性休克。结论选择合适病例,MPCNL术中联合负压吸引法一期治疗结石性脓肾安全有效。Objective To evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy com- bined with negative pressure equipment for treatment of selective calculus pyonephrosis at one-stage. Methods 27 cases ofcalculus pyonephrosisincluding 7 upper ureteral calculus cases, 9 purely renalpelvis calculus cases and 11 multiple renal calculus cases were treated with MPCNL. The size of the stone ranged from 1.2cm2 0. 7cm to 2.5cm2 1.8cm. All of them were established an access ofl8F. MPCNL combined with negative pressure installations was used in suction of the pus, and then to break and clear the calculus. In order to reduce the intrapelvic pressure and clear away the calculus effi- ciently, low pressure water flow perfusion and negative pessure installations was performed during the operation. Results Percutaneous renal access of 18F were established successfully and lithotripsy was performed at one-stage immediately. The average operative time was 38：[： 16 min. No residual stone fragment in 7 upper ureteral calculus cases. Of the other 20 cases, 15 cases were rendered stone-free and 5 eases had accepted a second-look MPCNL. The clearance rate was 81. 4%（22/27）at one-stage. 25 cases had suffered from fever after operation. No patients had sepsis and shock. Conclusion MPCNL combined with negative pressure equipment is safe and effective for the treatment of calculus pyonephrosis at one-stage.

关 键 词：尿路结石 脓肾 经皮肾镜取石术 

分 类 号：R692.4[医药卫生—泌尿科学]