一期经皮肾镜取石治疗上尿路结石合并肾积脓33例  

33 Cases of the treatment of upper urinary tract calculi complicated with pyonephrosis through one-stage renal calculi removal by percutaneous nephroscope

作　　者：王宽[1] 王朝明[1] 杨芒庄 

机构地区：[1]河南科技大学附属黄河医院泌尿外科,河南省三门峡市472000

出　　处：《中国综合临床》2017年第7期628-631,共4页Clinical Medicine of China

摘　　要：目的 探讨肾镜联合吸引器一期经皮肾取石治疗上尿路小负荷结石（结石总长径≤2 cm）合并术前未明确的肾积脓病例的疗效和安全性,以及手术中的操作要领. 方法 回顾性分析2010年8月至2016年3月我院收治的的上尿路小负荷结石合并肾积脓病例共33例,本组病例,术前无发热,血尿常规化验未提示明显感染,CT和彩超显示合并不同程度肾积水,均未提示肾积脓,术前均未抗感染治疗,肾积脓均为术中发现.先用吸引器通过经皮肾工作通道吸净脓液,并反复少量冲洗,直至吸出冲洗液清亮,然后一期经皮肾碎石取石,术中脓液送细菌培养,术后静脉抗感染治疗7~17d.观察其手术情况及术后血常规、体温、结石清除及其他临床恢复情况.结果 33例患者,均行一期单通道经皮肾镜碎石取石,手术顺利,手术时间28~59 min,平均41 min,术后1周内复查CT结石清除率为90.9%（30/33）,3例有结石残留,残留结石最大直径约6mm.术后3d内发热7例（21.2%）,4例超过38.5℃（12.1%）,术后3~6d之间发热2例（6.1%）,最高为38.0℃,手术6d后无发热病例.手术后血常规与术前相比提示手术相关血红蛋白下降为（6.16±5.21） g/L,术后3d血白细胞计数为（7.16±4.86）109/L,未出现脓毒血症、感染性休克、肾周脓肿、大出血等严重并发症.全部病例随访6~36个月.无继发性肾积脓或肾功能损害等并发症.结论 肾镜联合吸引器一期经皮肾取石治疗术前无发热的上尿路小负荷结石合并肾积脓,安全有效,可以作为基层医院的常规方法,但术中需操作仔细,动作轻柔,注意肾盂压力,避免并发症发生.Objective To investigate the efficacy and safety,as well as surgical essentials of upper urinary tract calculi （calculi being≤2 cm in diameter） complicated with pre-surgical uncertain pyonephrosis through one-stage renal calculi removal by percutaneous nephrolithotomy and suction device.Methods Retrospective analysis was used to detect the thirty-three cases with upper urinary tract calculi complicated with pre-surgical uncertain pyonephrosis collected from August 2010 to March 2016 in Yellow River Sanmenxia Hospital Affiliated to Henan University of Science and Technology,all the cases in the group had no pre-surgical fever,no apparent infection by blood-urine routine test,different degrees of hydronephrosis and no indications of pyonephrosis confirmed by CT and color Doppler ultrasonography,no pre-surgical anti-infection cure,pyonephrosis was found during the operation.First of all,a suction device was used to suck pus through percutaneous renal channel,rinsing repeatedly with small amount of fluid until the sucked rinsing fluid was clear;then,the one-stage calculi was removed by percutaneous renal lithotripsy,and the pus was sent to be cultured during the surgery,and the cases were treated by postoperative intravenous anti-infection for seven to seventeen days.Operation condition,postoperative blood routine,temperature,calculi removal and other clinical recovery conditions should be carefully observed.Results All the 33 cases underwent the one-stage single channel percutaneous nephrolithotom,the surgery was successful,the operation lasted 28-59 minutes,with an average of 41 minutes per case.Within the first-week of operation,CT reexamination showed the stone-free rate was 90.9% （30/33）,and three cases had residual stone,the maximum diameter was about 6mm;seven cases had high fever within 3 days after the surgery （21.2%）,and the temperature in four cases was higher than 38.5℃（12.1%） and two cases had fever within 3-6 days after surgery （6.1%）,the highest temperature reached 38.0℃,and n

关 键 词：上尿路结石 肾积脓 经皮肾镜 吸引器 

分 类 号：R699[医药卫生—泌尿科学]