经皮双通道肾穿刺造瘘并持续冲洗在肾积脓中的临床应用  

Clinical application of percutaneous dual-channel nephrostomy and continuous irrigation in the treatment of pyonephrosis

作　　者：吴俊雁 衡宝利 吴凡宇 Wu Junyan;Heng Baoli;Wu Fanyu(Yingde Center,Institute of Kidney Surgery,Jinan University,Department of Urology,People's Hospital of Yingde City,Yingde 513000,China)

机构地区：[1]暨南大学肾脏外科研究所英德基地英德市人民医院泌尿外科,513000

出　　处：《国际医药卫生导报》2020年第13期1818-1822,共5页International Medicine and Health Guidance News

基　　金：中央高校基本科研业务费专项资金资助项目(21618303);广东省医学科学技术研究基金项目(A2019571)。

摘　　要：目的探讨肾积脓在应用有效抗生素抗感染治疗下,如何加快感染控制的肾造瘘方法。方法收集2015年1月至2019年12月47例肾积脓患者资料,按治疗方式分为两组,单通道组行经皮单通道肾穿刺造瘘引流治疗,双通道组行经皮双通道肾穿刺造瘘并使用0.9%生理盐水肾盂低压对流冲洗治疗;观察患者术后体温变化、监测感染指标、观察肾造瘘管引流液转清时间,定期复查肾造瘘管引流液尿常规。结果单通道组和双通道组体温恢复平均时间分别为1.29 d和1.11 d,组间比较差异无统计学意义(P>0.05);双通道组血常规恢复时间平均为1.32 d,显著短于单通道组(1.75 d)(P<0.05);单通道组引流液转清时间平均为6.75 d、引流液尿常规恢复正常时间平均为6.96 d,而双通道组引流液转清时间平均为3.37 d、引流液尿常规恢复正常时间平均为3.79 d,二者时间均显著短于单通道组(均P<0.01)。结论行经皮双通道肾造瘘术并术后持续使用0.9%生理盐水肾盂低压对流冲洗治疗肾积脓较单通道组能更快更好地控制患肾局部感染,能更快地行二期手术,缩短患者住院时间,值得在临床上推广应用。Objective To investigate the method of how to accelerate infection control of nephrostomy under the application of effective antibiotics in anti-infective treatment of pyonephrosis.Methods A total of 47 patients with pyonephrosis from January 2015 to December 2019 were divided into two groups:the singlechannel group underwent percutaneous single-channel nephrostomy and drainage,and the dual-channel group underwent percutaneous dual-channel nephrostomy and the renal pelvis was irrigated by low-pressure convection with 0.9%normal saline.The change of body temperature,the monitoring on infection indicators,the clearance time of nephrostomy drainage fluid were observed,and the urine routine of nephrostomy tube drainage fluid was regularly reviewed.Results The average recovery time of body temperature in the single-channel group and the dual-channel group were 1.29 d and 1.11 d respectively,without statistically significant difference between the two groups(P>0.05).The average recovery time of blood routine in the dual-channel group was 1.32 d,which was significantly shorter than that in the single-channel group(1.75 d)(P<0.05).The average clearance time of drainage fluid in the single-channel group was 6.75 d,the average time of urine routine of drainage fluid recovery to normal was 6.96 d,those in the dual-channel group were 3.37 d and 3.79 d,which were significantly shorter than those in the single-channel group(all P<0.01).Conclusion Percutaneous dual-channel nephrostomy and continuous low-pressure convective irrigation of the renal pelvis with 0.9%normal saline for the treatment of pyonephrosis can control local infection of the kidney faster and better than the single-channel group,can perform the second-stage surgery faster and shorten the hospitalization time of patients,which is worth popularizing and applying in clinic.

关 键 词：肾积脓 双通道 经皮肾穿刺造瘘 持续冲洗 

分 类 号：R692[医药卫生—泌尿科学]