钬激光碎石负压吸引在输尿管结石梗阻性脓肾中的应用  

Application of Ureteroscopic Holmium Laser Lithotripsy Combined with Negative Pressure Suction to Ureteral Calculous Obstruction with Pyonephrosis

作　　者：张爱建 肖芝松 赵佳祥 郑宝寿 

机构地区：[1]大理大学附属医院泌尿外科,云南大理671000

出　　处：《现代临床医学》2016年第4期283-284,286,共3页Journal of Modern Clinical Medicine

摘　　要：目的：探讨输尿管镜下应用钬激光碎石联合负压吸引装置在治疗输尿管结石梗阻性脓肾中的安全性及有效性。方法：回顾性分析2014年6月至2015年6月期间我科应用输尿管镜钬激光碎石联合负压吸引装置治疗的9例输尿管结石梗阻性脓肾患者的临床资料。患者输尿管结石平均直径0.6~1.6 cm,术前尿常规提示感染,给予抗感染治疗,术中均有脓性尿液,先通过负压吸引持续吸出引流肾内脓液,再在负压吸引的作用下应用钬激光击碎结石并留置双J管充分引流。结果：9例患者均手术解除了梗阻并留置双J管充分引流,8例患者Ⅰ期碎石成功;1例因患者一般情况较差,留置双J管提前结束手术,Ⅱ期行输尿管镜碎石术。手术时间10~30 min,平均20 min。所有患者术后均无感染性休克等严重并发症发生,术后经抗感染治疗均治愈出院。结论：输尿管镜术中负压吸引吸出肾内脓液有利于降低肾内压力、控制感染。输尿管镜下应用钬激光碎石联合负压吸引装置可Ⅰ期治疗输尿管结石梗阻性脓肾,具有清石率高、安全有效、并发症少、恢复快等优点。Objective： To explore the safety and efficiency of ureteroscopic holmium laser lithotripsy combined with negative pressure suction in the management of ureteral calculous obstruction with pyonephrosis. Methods： From June 2014 to June 2015,a retrospective analysis was made in the clinical data of 9 patients with ureteral calculous obstruction and pyonephrosis undergoing ureteroscopic holmium laser lithotripsy combined with negative pressure suction. The average diameter of ureteral stones was 0. 6-1. 6 cm. The urine routine of all patients indicated infection before operation,and they were treated with antibiotics. In operation,a lot of pyoid urine was sucked out by negative pressure system. After that,Ureteroscopic holmium laser lithotripsy assisted by negative pressure suction was performed,and then the double-J stents were indwelt for drainage. Results： The obstruction was successfully relieved and double-J stents were indwelt for full drainage in 9 patients. 8 cases received successful one-stage lithotripsy,while a case underwent two-stage lithotripsy after only one-stage indwelling of double-J stent due to body weak condition. The average time of operation was 20 min（ 10-30 min）. All patients had no septic shock and other serious complications,and they were cured and discharged from hospital after anti-infection therapy. Conclusion： The negative pressure suction system is useful to reduce the intrarenal pressure and control infection. Ureteroscopic holmium laser lithotripsy combined with negative pressure suction can achieve one-stage success in the treatment of ureteral calculous obstruction with pyonephrosis.It is safe and effective with the advantages of less complication and fast recovery.

关 键 词：输尿管镜 钬激光碎石术 负压吸引 输尿管结石 脓肾 

分 类 号：R714.258[医药卫生—妇产科学]