不同时期取石治疗上尿路结石并感染性肾积水的疗效分析  

Analysis of Different Stage of Nephrolithotomy in the Treatment of Upper Urinary Calculi Complicated with Infective Hydronephrosis

作　　者：袁红纲[1] 董自强[1] 陈晓波[1] 颜克钧[1] 肖建华[1] Yuan Honggang;Dong Ziqiang;Chen Xiaobo;Yan Kejun;Xiao Jianhua(Department of Urology,Yichang Central People’s Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China)

机构地区：[1]三峡大学第一临床医学院[宜昌市中心人民医院]泌尿外科,湖北宜昌443003

出　　处：《巴楚医学》2022年第2期42-46,共5页Bachu Medical Journal

基　　金：国家自然科学基金项目(No:81300626)。

摘　　要：目的:探讨Ⅰ期取石术与Ⅰ期肾造瘘或置管引流后Ⅱ期取石术治疗上尿路结石并感染性肾积水的疗效。方法:回顾性分析2017年7月~2020年7月我院采用经皮肾镜取石术(PCNL)及输尿管镜钬激光碎石术(URS)或逆行输尿管软镜碎石术(RIRS)治疗上尿路结石并感染性肾积水446例患者临床资料。其中161例Ⅰ期先行肾穿刺造瘘引流术,待感染控制后,Ⅱ期行PCNL(A组);95例Ⅰ期直接行PCNL(B组)。137例Ⅰ期先行肾造瘘引流术,Ⅱ期行URS或RIRS(C组),53例Ⅰ期直接行URS或RIRS(D组)。比较患者不同时期取石的疗效。结果:A组手术时间、术中出血量、术后住院时间、并发症发生率明显低于B组(均P<0.05),Ⅰ期结石清除率明显高于B组(P<0.05);C组手术时间、术中出血量、术后住院时间、并发症发生率明显低于D组(均P<0.05),Ⅰ期结石清除率明显高于D组(P<0.05)。结论:Ⅰ期肾造瘘、置管引流,Ⅱ期行取石术治疗上尿路结石并感染性肾积水较Ⅰ期取石术更安全、有效。Objective: To compare clinical efficacy between one-stage nephrolithotomy and second-stage nephrolithotomy after nephrostomy or catheter drainage in treatment of stone infected hydronephrosis. Methods: Retrospective analysis was performed on the clinical data of 446 patients with upper urinary calculi and infectious hydronephritis who underwent percutaneous nephrolithotomy(PCNL) or ureteroscopic holmium laser lithotripsy(URS) or retrograde intrarenal surgery(RIRS) in our hospital from July 2017 to July 2020. Among them, there were 161 patients subjected with one-stage percutaneous nephrostomy and second-stage PCNL(group A), 95 patients with one-stage direct PCNL(group B). While, 137 patients were treated with one-stage percutaneous nephrostomy and second-stage URS or RIRS(group C), 53 patients with one-stage direct URS or RIRS(group D). The clinical efficacy among different stage of nephrolithotomy were compared. Results: The operation time, intraoperative blood loss, postoperative hospital stay and incidence of complications were significantly lower, while the first-stage stone clearance rate was obviously higher in group A than those in group B(all P<0.05). The operation time, intraoperative blood loss, postoperative hospital stay and incidence of complications were significantly lower, while the first-stage stone clearance rate was greatly higher in group C than those in group D(all P<0.05). Conclusion: It is safer and more effective to use second-stage nephrolithotomy after one-stage nephrostomy or catheter drainage instead of one-stage direct nephrolithotomy in the treatment of stone infected hydronephrosis.

关 键 词：经皮肾镜取石术 输尿管镜钬激光碎石术 上尿路结石 感染性肾积水 

分 类 号：R692.2[医药卫生—泌尿科学]