零压力经皮肾镜术联合免持气压弹道碎石一期治疗15例结石性脓肾的疗效初探(“大家泌尿网”观看手术视频)  

Efficacy of zero-pressure percutaneous nephrolithotomy combined with hands-free pneumatic lithotripsy in the one-stage treatment of calculous pyonephrosis

作　　者：吴中华 王永志 陈平[1] 刘同族[1] 李兵 王行环[1] WU Zhonghua;WANG Yongzhi;CHEN Ping;LIU Tongzu;LI Bing;WANG Xinghuan(Department of Urology,Zhongnan Hospital of Wuhan University,Institute of Urology,Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院泌尿外科,武汉大学泌尿外科研究所,湖北武汉430071

出　　处：《现代泌尿外科杂志》2024年第12期1047-1050,共4页Journal of Modern Urology

基　　金：武汉大学中南医院科技成果转化基金项目(No.2022CGZH-MS008)。

摘　　要：目的评估零压力经皮肾镜术(PCNL)联合免持气压弹道碎石技术在一期治疗非急性感染期结石性脓肾患者中的疗效及安全性。方法回顾性分析武汉大学中南医院2022年2月—2023年12月收治的15例非急性感染期结石性脓肾患者的临床资料,手术均采用双鞘负压吸引PCNL联合免持气压弹道碎石技术,术中采用零压力重力灌注,灌注高度为患者肾脏水平或不超过肾脏上方20 cm,分析患者的临床资料及术后随访结果。结果本组患者结石直径中位数(范围)为28(22~40)mm,中位结石密度1028(765~1305)Hu。15例患者手术均成功完成。中位手术时间55(35~90)min。术后低热(ClavienⅠ)1例,高热(ClavienⅡ)1例,无ClavienⅢ以上并发症发生。术后即刻结石清除率为73.3%,术后1个月的结石清除率为93.3%。结论对于非急性感染期结石性脓肾患者,采用零压力PCNL联合免持气压弹道碎石技术的一期治疗疗效及安全性良好,可在临床推广应用。Objective To evaluate the efficacy and safety of zero-pressure percutaneous nephrolithotomy(PCNL)combined with hands-free pneumatic lithotripsy in the one-stage treatment of calculous pyonephrosis in the non-acute infection phase.Methods Clinical data of 15 patients treated during Feb.2022 and Dec.2023 were retrospectively analyzed.Double-sheath negative pressure PCNL was adopted,with zero-pressure gravity perfusion where the perfusion height was at the level of the patients kidney,not exceeding 20 cm above the kidney.Pneumatic lithotripsy was performed without the need to hold the device with hand.Results The median stone diameter was 28(range 22—40)mm,with a median stone density of 1028(range 765—1305)Hu.All operations were successful.The median operation time was 55(range 35—90)min.Postoperative low fever(Clavien gradeⅠ)occurred in 1 case,and high fever(Clavien gradeⅡ)occurred in 1 case,with no complications of Clavien gradeⅢor above.The initial stone-free rate was 73.3%,and the stone-free rate after one month was 93.3%.Conclusion For patients with calculous pyonephrosis in the non-acute infection phase,one-stage treatment using zero-pressure PCNL combined with hands-free pneumatic lithotripsy demonstrates good efficacy and safety.

关 键 词：经皮肾镜术 结石性脓肾 零压力 免持气压弹道碎石 结石清除率 

分 类 号：R693[医药卫生—泌尿科学]