硕通镜在治疗上尿路结石梗阻性脓肾中的应用  

Application of Shuo Tong ureteroscopy in treating upper urinary tract stone complicated with pyonephrosis

作　　者：潘东升[1] 赵兴华[1] 许长宝[1] 郝斌[1] 王晓甫[1] 刘昌伟[1] 李武学[1] 刘凯 冀明阳 PAN Dongsheng;ZHAO Xinghua;XU Changbao;HAO Bin;WANG Xiaofu;LIU Changwei;LI Wuxue;LIU Kai;JI Mingyang(Department of Urology Surgery, Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China)

机构地区：[1]郑州大学第二附属医院泌尿外科,郑州450000

出　　处：《临床与病理杂志》2018年第12期2616-2620,共5页Journal of Clinical and Pathological Research

摘　　要：目的:探究硕通镜在治疗上尿路结石梗阻性脓肾中的临床价值。方法:选取2016年10月至2018年2月在郑州大学第二附属医院泌尿外科实施硕通镜治疗的106例上尿路结石梗阻性脓肾患者的临床资料进行分析。患者均于明确诊断后择期进行硕通镜手术治疗。观察患者手术时间、术后住院时间、手术结石清除率和术后发热及并发症情况,术后随访周期为1个月。结果:所有患者手术过程顺利。手术时间27～65(37±12)min,术后住院时间3～7(4.3±2.1)d,术后第1天和1个月后复查腹部平片(KUB)或CT提示清石率分别为81.1%(86/106)和96.2%(102/106)。2例术后出现发热(≥38.5℃),1例患者术后出现尿脓毒血症,及时给予氢化可的松、泰能、补液等对症治疗后病情好转。1个月后复查影像学示4例仍有结石残留,行2期输尿管软镜碎石清石或者辅以体外冲击波碎石治疗后结石完全排出。6例因术中发现输尿管狭窄,1个月后给予更换输尿管支架管,其余均给予拔除输尿管支架管。所有患者术后无大出血、肾功能不全、肾周血肿、输尿管石街、撕脱、穿孔等严重并发症发生,均经积极对症治疗后痊愈出院。结论:利用硕通镜治疗上尿路结石梗阻性脓肾临床效果显著,清石率高,临床效果安全、可靠,值得推广应用。Objective: To explore the clinical value of Shuo Tong ureteroscopy in the treatment of upper urinary tract stones with pyonephrosis. Methods: The data of 106 patients with upper urinary tract calculi combined with pyonephrosis who underwent Shuo Tong ureteroscopy treatment in our department from October 2016 to February 2018 were retrospectively analyzed. All patients underwent elective surgical treatment after definitive diagnosis. The operation time, length of stay, tone free rate, postoperative fever and complications were observed. The period was 1 month. Results: All operations were successful. The operation time was 27–65 (37±12) minutes. The total hospitalization time was 3–7 (4.3±2.1) days. Two cases had postoperative fever (≥38.5 °C);1 patient developed urinary sepsis after operation. After the timely application of hydrocortisone, Tienam, rehydration and other symptomatic treatments, the patient’s condition eventually recovered. The KUB or CT examination on the first postoperative day and 1 month after the operation suggested that the rate of stone clearance was 81.1%(86/106) and 96.2%(102/106), respectively;4 patients still indicated residual stones were completely discharged after 2nd stage Flexible ureteroscope or lithotripsy supplemented with extracorporeal shock wave lithotripsy. In 6 cases, the ureteral stricture was found during the operation. The ureteral stent was replaced after 1 month and the rest patients was removed. All patients had no major bleeding, renal insufficiency, perirenal hematoma, ureteral stone street, avulsion, perforation and other serious complications. All patients were cured and discharged after active symptomatic treatment. Conclusion: The use of Shuo Tong ureteroscopy for the treatment of upper urinary tract obstructive pyonephrosis has a significant clinical effect, high rate of Stone free, and the clinical effect is safe and reliable. It can be popularized and applied.

关 键 词：硕通镜 上尿路结石 脓肾 清石率 

分 类 号：R699[医药卫生—泌尿科学]