经皮肾穿刺微造瘘与内引流分期治疗结石性脓肾的疗效分析  

Effect analysis of percutaneous renal puncture microstomy and internal drainage in the treatment of calculous pyonephrosis by stages

作　　者：李腾林 淡明江 张焕涛 LI Tenglin;DAN Mingjiang;ZHANG Huantao(Department of Urology,Hui Ya Hospital of The First Affiliated Hospital,Sun Yat-sen University,Huizhou,Guangdong,516081,China)

机构地区：[1]惠州市中大惠亚医院泌尿外科,广东惠州516081

出　　处：《当代医学》2021年第22期90-92,共3页Contemporary Medicine

摘　　要：目的探讨经皮肾穿刺微造瘘与内引流分期治疗结石性脓肾的疗效。方法选取本院2016年9月至2019年1月收治的80例结石性脓肾患者,一期行皮肾穿刺微造瘘或内引流治疗,二期行经皮肾镜取石术、经尿道输尿管镜取石术或肾切除术治疗,观察治疗效果及预后。结果80例结石性脓肾患者中,一期行经皮肾穿刺微造瘘术70例,行经尿道输尿管镜下置双J管内引流术10例,手术治疗后病情均快速平稳康复;二期行腔内取石术75例,其中行经尿道输尿管镜取石术15例,一次取净15例(100.00%),行经皮肾镜取石术60例,全部取净55例(91.67%),均未发生严重并发症。75例保肾患者随访6个月,结果显示,轻中度组患肾功能好转率高于重度肾组,上尿路反复感染发生率低于重度肾组,差异均有统计学意义(P<0.05)。70例一期行经皮肾穿刺微造瘘术保留患肾患者随访6个月,结果显示,造瘘术后1 d,引流量≥200 mL组患者患肾功能好转率高于引流量<200 mL组,上尿路反复感染发生率低于引流量<200 mL组,差异均有统计学意义(P<0.05)。结论在对结石性脓肾患者的临床治疗中,经皮肾穿刺微造瘘与内引流分期治疗理想,且术前肾功能受损程度轻,造瘘术后1 d平均引流量≥200 mL的患者的治疗效果及预后更佳。Objective To investigate the curative effect of percutaneous renal puncture microstomy and internal drainage in the treatment of cal-culous pyonephrosis by stages.Methods 80 patients with calculous pyonephrosis admitted to our hospital from September 2016 to January 2019 were selected.In the first stage,percutaneous nephrolithotomy microstomy or internal drainage were performed,and in the second stage,percutane-ous nephrolithotomy,tranureteral ureteroscopic lithotomy or nephrectomy were selectively performed for appropriate conditions.The therapeutic ef-fect and prognosis were observed.Results Among the 80 patients with calculous pyonephrosis in the first stage,70 cases underwent percutaneous nephroentesis microstomy and 10 cases underwent transurethral ureteroscopic double J tube drainage.After surgical treatment,their conditions recov-ered quickly and steadily;in the second stage,75 patients underwent endoscopic lithotomy,15 cases underwent transurethral ureteroscopic lithotomy,one-time purification accounted 15 cases(100.00%)and 60 cases underwent percutaneous nephrolithotomy,underwent total lithotomy of 55 cases(91.67%).No serious complications occurred in all patients.75 patients with kidney preservation were followed up for 6 monthes,and the results showed that the improvpatientsement rate of renal function in patients with mild and moderate renal impairment was higher than that in patients with severe renal impairment,and the incidence of repeated upper urinary tract infection was lower than that in patients with severe renal impairment,the difference was statistically significant(P<0.05).70 cases underwent percutaneous nephrolithotomy microstomy in the first stage were followed up for half a year,the result showed that 1 d after fistulation,the rate of improvement in renal function of the patients with drainage volume≥200 mL group was higher than that of the patients with drainage volume<200 mL group,the incidence of repeated infection of upper urinary tract was lower than that of patients with drainage

关 键 词：经皮肾镜取石术 穿刺 造瘘术 内引流 结石性脓肾 

分 类 号：R699.2[医药卫生—泌尿科学]