经皮肾镜碎石术应用负压吸引Ⅰ期处理结石性脓肾的疗效分析  

Analysis of the treatment of calculus pyonephrosis with percutaneous nephrolithotomy combined with negative pressure suction at one-stage

作　　者：黄海鹏[1] 赵令云 林伟[1] 黄跃胜[1] 朱心燊[1] 熊焕腾[1] 熊星[1] HUANG Haipeng;ZHAO Lingyun;LIN Wei(Department of Urology,Jiangxi Provincial People's Hospital Affiliated to Nanchang University,Nanchang 330006,China;Department of Urology,Xiangdong District People's Hospital,Pingxiang 337000,China)

机构地区：[1]江西省人民医院南昌大学附属人民医院泌尿外科,南昌330006 [2]江西省萍乡市湘东区人民医院外二科,萍乡337016

出　　处：《江西医药》2020年第12期1766-1769,共4页Jiangxi Medical Journal

基　　金：江西省卫健委科技计划项目,编号20185008。

摘　　要：目的探讨微创经皮肾镜取石术(mPCNL)中应用负压吸引一期处理结石性脓肾的安全性及疗效。方法选择2014年6月-2020年6月我院73例术前无感染征兆的伴有脓肾的结石患者为研究对象。其中实施Ⅰ期mPCNL(Ⅰ期组)42例;微创经皮肾造瘘引流抗感染治疗后再择期行Ⅱ期mPCNL(Ⅱ期组)31例。Ⅰ期组男24例,女18例;年龄(35.8±10.2)岁;结石直径(25.3±8.2)mm。Ⅱ期组男19例,女12例;年龄(33.2±9.4)岁;结石直径(28.7±7.9)mm。Ⅰ期组留置F16或F18Peel-away塑料鞘建立手术通道。先接上负压吸引吸出脓液,液压灌注泵冲洗5s后,再负压吸引吸出脓液,使用60W钬激光逐步粉碎结石,Ⅱ期组留置F16肾造瘘管,保持引流通畅。然后按照前述方法行Ⅱ期经皮肾镜钬激光碎石术。结果两组在碎石手术时间、结石清除率无显著差异(P>0.05);总住院时间、造瘘管留置时间、总住院费用上差异有统计学意义(P<0.05)。两组术后并发症发热比较统计学无显著差异(P>0.05)。结论经皮肾镜碎石术应用负压吸引Ⅰ期处理结石性脓肾安全有效。Objective To explore the safety and efficacy of minimally invasive percutaneous nephrolithotomy combined with negative pressure suction for treatment of calculus pyonephrosis at one-stage.Methods We retrospectively analyzed the clinical data of 73 patients with calculus pyonephrosis had no signs of infection before the operation from Jun 2014 to Jun 2016,including 42 cases underwent minimally invasive percutaneous nephrolithotomy at one-period(Phase I group);31 cases were electively performed minimally invasive percutaneous nephrolithotomy after minimally percutaneous nephrostomy drainage anti-infection treatment(Phase II group).In the first-stage group,there were 24 males and 18 females;their age was(35.8±10.2)years;the diameter of stones was(25.3±8.2)mm.In the second stage group,there were 19 males and 12 females;their age was(33.2±9.4)years;the diameter of stones was(28.7±7.9)mm.In the first-stage group,F16 or F18 Peel-away the plastic scabbard was indwelled to establish the surgical channel.First,connect the negative pressure suction to suck out the pus.After flushing with the hydraulic perfusion pump for 5 seconds,the negative pressure suction to suck out the pus.The 60W holmium laser was used to gradually smash the stones.The F16 nephrostomy tube was indwelled in the second stage group to maintain smooth drainage.Then according to the aforementioned method,Percutaneous holmium laser lithotripsy was performed.Results There were no significant differences in lithotripsy operation time and stone clearance rate between the two groups(P>0.05);there were statistically significant differences in total hospital stay,fistula indwelling time,and hospitalization costs(P<0.05).There was no significant difference in postoperative complications of fever between the two groups(P>0.05).Conclusion Percutaneous nephrolithotomy with negative pressure suction is safe and effective for the treatment of calculus pyonephrosis at one-stage.

关 键 词：尿路结石 脓肾 经皮肾镜取石术 

分 类 号：R699.2[医药卫生—泌尿科学]