一期或分期mini-PCNL治疗肾盂结石伴积脓38例临床分析  

Clinical analysis of 38 cases with one or staging treatment for patients with renal pelvis calculi complicated with pyonephrosis in minimally invasive percutaneous nephrolithotomy

作　　者：周兴祝[1] 唐庆来[1] 吕建林[1] 柳发德[1] 惠继红[1] 王杜渐[1] 

机构地区：[1]南京医科大学附属江宁医院泌尿外科,江苏南京211100

出　　处：《东南大学学报（医学版）》2015年第4期620-622,共3页Journal of Southeast University(Medical Science Edition)

摘　　要：目的：探讨肾盂结石伴积脓患者mini-PCNL术中处理方法。方法：本研究回顾性分析了我院2006年5月至2014年12月间收治的肾盂结石伴积脓的患者共38例,年龄21-65岁,平均45岁,患者经皮肾穿刺引出脓液后17例仅行经皮肾造瘘术,两周后行二期mini-PCNL;21例患者术中充分引流脓液、应用庆大霉素生理盐水低压冲洗后一期行钬激光碎石术。结果：17例二期手术患者中,15例获得良好的治疗效果,2例有残石,再次行mini-PCNL术;术后发生全身炎症反应综合征者2例。21例一期手术者中,20例获得良好的治疗效果;1例有残石,行体外冲击波碎石;术后发生全身炎症反应综合征1例。结论：肾盂结石伴积脓miniPCNL术中行充分引流、抗生素液低压冲洗后对于合适的患者可以进行一期碎石,安全性有待临床进一步证实。Objective： To discuss the treatment for patients with renal pelvis calculi complicated with pyonephrosis in minimally invasive percutaneous nephrolithotomy（ mini-PCNL）. Methods： The patients with renal pelvis calculi complicated with pyonephrosis treated in our hospital from May 2006 to December 2014 were analyzed retrospectively. A total of 38 cases,age 21- 65 years old,average 45 years,17 cases of which underwent percutaneous nephrostomy performed the two-stage mini-PCNL after 2 weeks; and 21 patients underwent one-stage holmium laser lithotripsy after sufficient drainage of pus and low pressure flush with gentamicin physiological saline.Results： During 17 cases of two-stage operation patients,2 cases suffered the postoperative systemic inflammatory response syndrome（ SIRS）. 15 cases operated successfully and 2 cases with residual stones underwent mini-PCNL operation again; During 21 cases of one-stage operation patients,1 case suffered the postoperative SIRS. 20 cases operated successfully and 1 case with residual stones underwent extracorporeal shock wave lithotripsy. Conclusion：Our data reveal that one-stage mini-PCNL after sufficient drainage of pus and low pressure flush with gentamicin physiological saline has not increased the occurrence of SIRS,and show these advantages including short course of treatment,simplicity,practicality; but safety should be further clinically confirmed.

关 键 词：肾盂积脓 结石 经皮肾镜碎石 

分 类 号：R692.4[医药卫生—泌尿科学] R692.7[医药卫生—外科学]