mPCNL一期治疗上尿路结石合并肾积脓患者的临床研究  

A clinical study of mini-percutaneous nephrostolithotomy in first stage treatment of upper tract calculus complicated with pyonephrosis

作　　者：童方运 陈合群[2] 马楠 曾峰[2] 龙晓丹[4] 崔雨[2] 

机构地区：[1]湖南省儿童医院泌尿二科,湖南长沙410000 [2]中南大学湘雅医院泌尿外科,湖南长沙410008 [3]泰和医院,湖南长沙410000 [4]娄底市中心医院,湖南娄底417000

出　　处：《国际泌尿系统杂志》2015年第5期658-663,共6页International Journal of Urology and Nephrology

摘　　要：目的 探讨一种经济简单有效的措施,能保障上尿路结石合并肾积脓患者行一期mPCNL的安全性,尽量减少手术次数,减轻患者的负担.方法 2011年12月～2013年5月间,前瞻性收集在中南大学湘雅医院泌尿外科应用mPCNL一期治疗上尿路结石且符合入选标准的患者资料进行分组对照研究.将病例分为实验组：合并脓肾术中予以稀释络合碘冲洗者;对照组：同期非脓肾患者.比较两组患者的术后发热情况（血常规、发热程度、发热天数）、冲洗后穿刺液培养结果、术后住院时间等,重点比较术后发热情况及穿刺液培养结果.数据采用SPSS19.0进行统计分析.结果 本课题选取的51例患者均行mPCNL顺利完成了手术,其中22例为术中穿刺确诊为脓肾的患者,予稀释的络合碘冲洗后行一期碎石取石,对照组有29例.实验组穿刺液冲洗前后细菌培养结果经x2检验,P ＜0.05,差异有统计学意义,冲洗前后存在明显差异;实验组术后平均发热天数为1.52 ±0.59d,对照组术后平均发热天数为1.00±1.01d,采用单因素方差分析,P ＞0.05,无明显差异;实验组术后白细胞为9.05±2.95（×109/L）,对照组术后白细胞为8.68±2.81（×109/L）,采用单因素方差分析,P＞0.05,无明显差异;实验组术后中性比为83.65±9.83％,对照组术后中性比为86.04 ±7.87％,采用单因素方差分析,P＞0.05,二者无明显差异;实验组术后平均住院时间8.84±0.37d,对照组术后平均住院时间8.14±1.82d,采用单因素方差分析,P＞0.05,二者无明显差异.结论 对于术中穿刺确诊为脓肾的患者,采用稀释络合碘冲洗后一期行经皮肾镜碎石取石术经疗效分析是安全的、可靠的,术后并发症少,恢复快,临床证实有效。Objectives To explore a economical,simple and effective measure that can ensure the safety of upper tract calculus complicated with pyonephrosis patients with the first stage mini-percutaneous nephrostolithotomy,and also reduce the number of operations,lighten the burden of patients.Methods This was a prospective trial of group control study,the trial of the patients who undergoing first stage mPCNL between December 2011 and April 2013 in xiangya hospital of central-south university.and the patients must correspond with group measure.The patients are divided into the experimental group and the control group.The experimental group was patients with pyonephrosis flushed with dilute complexing iodine;The control group was the common patients.Compare two groups of patients with postoperative fever（routine blood 、degree of fever、days of fever） 、culture results of puncture fluid after washing 、hospital stays of postoperation.The first two results were mainly compared.The data was analyzed by SPSS19.0.Results Fifty-one patients in this topic were performed mPCNL successfully,twety-two patients were diagnosed pyonephrosis during operation and then accepted the first stage mini-percutaneous nephrolithotomy after flushed with dilute complexing iodine,There were twenty-nine patients in the control group.In experimental group,the cultivate results of punctured fluid before and after flushed were statistical significance （by chi-square test,P 〈 0.05）,the averaged postoperative fever days of experimental group were 1.52 ± 0.59 days,The control group were 1.00 ± 1.01 days,there was no statistical significance（by one-factor analysis of variance,P 〉 0.05）,the postoperative leukocyte of experimental group were 9.05 ± 2.95 （× 109 / L） and the control group were 8.68 ± 2.81 （× 109 / L）,there were no statistical significance（by one-factor analysis of variance,P 〉 0.05）,the postoperative neutrophils ratio of experimental group were 83.65 ± 9.83% and the control group were 86.04 ± 7.87%,the

关 键 词：尿路结石 肾造口术 经皮 

分 类 号：R691.4[医药卫生—泌尿科学]