经皮肾镜取石术治疗合并肾结核之上尿路结石的临床分析  

Clinical analysis of treatment of upper tract urinary calculi combined with renal tuberculosis by percutaneous nephrolithotomy

作　　者：王坚[1] 周大庆[1] 王封景[1] 邹汉琦[1] 邓程慧[1] 

机构地区：[1]中国人民解放军303医院泌尿外科,广西南宁市530021

出　　处：《微创医学》2014年第4期412-413,411,共3页Journal of Minimally Invasive Medicine

摘　　要：目的探讨经皮肾镜取石术治疗上尿路结石合并肾结核的可行性。方法行经皮肾镜术后确诊的肾结核病人4例,肾结石3例,肾结石合并输尿管上段结石1例;术前可疑肾积脓2例,行结核相关检查,结果提示阴性。4例患者均行经皮肾镜碎石取石术,术中发现肾内均有不同程度积脓,予吸净脓液,用超声碎石取石,术毕取病理活检。结果术后病理结果提示肾结核3例,随访1～2年,病情治愈,肾盂黏膜慢性炎症1例,术后肾造瘘通道反复流脓,抗结核治疗半年后行患肾切除,术后病理报告为肾结核。结论结核合并结石并非经皮肾镜手术的绝对禁忌证,结合有效抗结核治疗,行经皮肾镜取石术可有效缩短病程,保留肾功能。Objective To study the feasibility of treating upper tract urinary calculi combined with renal tuberculosis by percutaneous nepbrolithotomy （PCNL）. Methods Of 4 patients diagnosed as renal tuberculosis after PCNL, 1 complicated with renal calculi alone, and 3 with upper ureteral calculi in addition. Preoperative exam showed 2 suspected pyonephrosis without tuberculosis evidence. All 4 patients were performed with PCNL and found pyonephrosis in various degrees which were sucked out completely, and sequentially treated with EMS LithoClast mast and performed with biopsy. Results Postoperative pathological results showed 3 renal tuberculosis that were cured and followed for 1 to 2 years, and 1 chronic pelvic inflammation that were performed with nephrotomy after half a year of anti-tuberculosis treatment for postoperative repeated pus dripping at nephrostomy tract fistula and were diagnosed as renal tuberculosis by following repeated pathological check. Conclusions Calculi complicated with tuberculosis is not absolute contraindication for PCNL treatment. In combination anti-tuberculosis therapy, PCNL can effectively shorten the course of the disease and preserve the function of kidney.

关 键 词：肾结核 经皮肾镜取石术 泌尿系结石 

分 类 号：R699[医药卫生—泌尿科学]