输尿管软镜在多重耐药菌感染且CT值<1000 HU鹿角形肾结石治疗中的应用(附11例报告)  

Application of Flexible Ureteroscopic Lithotripsy in the Treatment of Multi-drug Resistant Infections With CT Value < 1000 HU Staghorn Calculi: Report of 11 Cases

作　　者：余昆[1] 石国忠[1] 余志海[1] 刘美平[1] Yu Kun;Shi Guozhong;Yu Zhihai(Department of Urology, Chongqing Three Gorges Central Hospital, Affiliated Three Gorges Hospital of Chongqing Medical University, Chongqing 404000, China)

机构地区：[1]重庆三峡中心医院重庆医科大学附属三峡医院泌尿外科

出　　处：《中国微创外科杂志》2019年第7期592-596,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨输尿管软镜碎石术(flexible ureteroscope lithotripsy,FURL)治疗多重耐药菌感染鹿角形肾结石的有效性和安全性。方法我院2016年9月~2018年3月采用FURL治疗合并多重耐药菌感染的鹿角形肾结石11例,结石CT值319~760 HU,(582. 7±122. 9) HU。术前常规行输尿管双J管置入以扩张输尿管,解除泌尿系梗阻,充分内引流,1~4周后再行FURL。术中留置F14/16输尿管软镜导引鞘,置入输尿管软镜后行钬激光碎石,术后1个月复查尿路平片或腹部CT平扫,根据残留结石大小采取体外震波碎石(extracorporeal shock wave lithotripsy,ESWL)或二期甚至三期FURL。结果 11例均顺利完成FURL,术中发现结石均易碎、表面粗糙、形状不规则、灰白色或棕黄色。碎石时间83~217 min,平均138. 5 min。术后结石成分分析为碳酸磷灰石、磷酸镁铵、尿酸盐等一种或几种成分的混合物。术后住院时间2~4 d,(2. 7±0. 9) d。术后发生全身炎症反应综合征3例,经积极抗感染及对症支持治疗后痊愈。1例一期完全粉碎并排出结石;1例一期FURL术后1个月联合ESWL,结石完全排净;9例一期FURL术后1个月行二期FURL,8例成功清除残留结石,1例二期FURL术后1个月再次行三期FURL,术中发现肾盂肾下盏漏斗夹角<30°致肾下盏结石清石失败,术后辅以ESWL后残留结石约0. 8 cm。总清除结石率90. 9%(10/11)。结论对于CT值<1000 HU的感染性鹿角形肾结石,FURL是一种安全可靠、疗效确切、并发症少的治疗方法。Objective To evaluate the efficacy and safety of flexible ureteroscopy lithotripsy (FURL) in the treatment of staghorn calculi with multi-drug resistant infections. Methods From September 2016 to March 2018, 11 cases of renal staghorn calculi with multiple drug-resistant bacterial infections were treated by FURL in our hospital. The CT value of the calculi was 319-760 HU, with an average of (582.7±122.9) HU. Preoperative ureteral double J tube placement was performed to dilate the ureter, relieve urinary obstruction, and conduct internal drainage. After 1-4 weeks, FURL was performed. Intraoperative F 14/16 ureteral soft-guided sheath was placed. The flexible ureteroscope was placed and the holmium laser lithotripsy was performed. The kidney, ureter, bladder (KUB) X-ray or abdominal CT scanning was performed at 1 month after surgery, and the residual stones were treated with ESWL or Phase Ⅱ or Ⅲ FURL. Results All the patients underwent FURL successfully. The stones were found to be brittle, with rough surface, irregular shaped, grayish white or brownish yellow in color. The total time of lithotripsy was 83-217 min (mean, 138.5 min). The postoperative calculus composition analysis showed a mixture of carbonate apatite, magnesium ammonium phosphate, urate and so on. The postoperative hospitalization time was 2-4 days (mean, 2.7±0.9 days). Postoperative systemic inflammatory reaction syndrome (SIRS) occurred in 3 patients, who recovered after active anti-infection and symptomatic support treatment. One case of staghorn calculi was completely pulverized and discharged in the first stage. One case was given ESWL at 1 month after the first stage FURL with stones completely exhausted. Nine patients underwent the second-stage FURL at 1 month after the first stage FURL, with 8 of them succeeded in removing residual stones. One patient underwent the third-stage FURL after the second phase operation. The infundibulopelvic angle (IPA) was found < 30° which caused the failure of being cleared subrenal calyx calculus. Th

关 键 词：鹿角形肾结石 输尿管软镜 多重耐药菌 CT值 

分 类 号：R699.2[医药卫生—泌尿科学]