经皮肾镜碎石术分期处理结石性脓肾的疗效分析

目的:评价经皮肾镜钬激光碎石术分期治疗结石性脓肾的安全性和治疗效果。方法:回顾性分析2009年6月~2013年9月收住的65例结石性脓肾患者临床资料:分别在B超引导下完成经皮肾镜钬激光碎石术,其中29例为Ⅰ期经皮肾镜钬激光碎石术(Ⅰ期组),36例为Ⅰ期穿刺引流后行Ⅱ期经皮肾镜钬激光碎石术(Ⅱ期组)。结果:两组均顺利完成手术。Ⅰ期组术后发热9例,高热4例,菌血症1例,肾周感染2例;Ⅰ期结石清除率为75.8%,结石残余7例(5例1cm);造瘘管留置时间为(5.69±1.51)d,术后住院时间分别为(7.58±1.97)d,总住院时间为(14.46±4.47)d,总住院平均费用为(20 134±3 930)元。Ⅱ期组术后发热6例,高热2例,感染性休克1例;结石清除率为88.9%,结石残余4例(均1cm);总住院时间平均为(19.53±5.65)d,造瘘管留置时间为(11.17±1.63)d,术后住院时间分别为(6.39±2.54)d,总住院平均费用为(28 261±3 191)元。比较造瘘管留置时间、总住院时间、住院费用等,两组差异有统计学意义(P0.05)。均未出现肾切除、大出血、腹腔脏器损伤等严重并发症。结论:Ⅰ期经皮肾镜钬激光碎石术可有效减少患者术后留置造瘘管时间和住院时间,降低住院费用,通过有效的术前准备,注意术中操作细节,对选择性结石性脓肾患者是一种安全有效的治疗方法。

Analysis of the periodic treatment for calculous pyonephrosis with percutaneous nephrolithotripsy

Objective： To investigate the curative effect and the safety of the periodic treatment for calculous pyonephrosis with percutaneous nephrolithotripsy （PCNL） combined with holmium laser. Method： We retrospectively reviewed 65 cases with calculous pyonephrosis treated by B-guided PCNL in our department. Twenty nine cases underwent PCNL in stage Ⅰ （stage Ⅰ group） and 36 patients selected puncturing and drainage in stage Ⅰ and PCNL in stageⅡ （stage Ⅱ group） from June 2009 to September 2013. Result：Two groups of patients were successfully operated. In stage I group nine cases were found postoperative fever, four cases were found high fe- ver, one case was found bacteremia, and two cases were found perirenal infection. Other clinical data of stage I group were as follows., stone clearance rate was 75.8%; seven cases had residual stones （five cases〈1. 0 cm）; fistula retention time was （5.69±1.51） d; postoperative hospital stay was （7.58± 1.97） d; total hospital stay was （14.46±4.47） d; total hospital expenses were （20 134±3 930） yuan. In stage Ⅱ group, six cases suffered from postoperative fever, two cases suffered from high fever, and one case suffered from septic shock. Other clinical data of stage Ⅱ group were as follows., stone clearance rate was 88.9%; four cases had residual stones （〈1 cm） Ⅱ fistula retention time was （11.17±1.63） d; postoperative hospital stay was （6.39±2.54） d; total hospital stay was （19.53±5.65） d; total hospital expenses were （28 261±3 191） yuan. The differences were statistically significant （P〈0.05） between two groups in fistula retention time, total hospital stay and hospital expenses. Mo- reover, no serious complications of renal resection, bleeding or abdominal organ injury happened. Conclusion：One- stage operation can reduce fistula retention time, postoperative hospital stay and hospital expenses effectively, through adequate preoperative preparation, and attention to the operational details of surgery. One-stage PCNI. is safe and effective for patiets with selective calculous pyonephrosis.