选择性标准通道经皮肾镜Ⅰ期治疗结石性脓肾

目的 探讨标准通道经皮肾镜Ⅰ期治疗结石性脓肾的安全性和有效性.方法 2006年8月至2012年10月,有选择性对146例术前均未进行引流的结石性脓肾患者,围手术期在给予抗感染等综合干预措施下采用EMS三代碎石清石系统行彩超引导下标准通道经皮肾镜Ⅰ期治疗,对齐临床资料进行回顾性分析.结果 146例结石性脓肾患者均顺利完成手术.一次手术1 15例,二次手术31例.单标准通道110例,双标准通道36例.手术时间18～69 min,平均（43±7） min;出血量20～96 ml,平均出血量约（39±8）ml.无肾切除、介入栓塞、感染性休克、大出血、大血管和胸腹腔脏器损伤等严重并发症发生.12例残余结石直径≥0.6 cm（0.6～0.8 cm）,行体外冲击波碎石治疗,结石清除率91.8％.14例患者失访.132例患者随访6～61个月,129例肾功能不同程度恢复,3例肾萎缩.结论 彩超引导下标准通道经皮肾镜Ⅰ期治疗结石性脓肾安全有效,保肾率高,注意病例应有选择性且围手术期应采取抗感染等综合干预措施.

Selective standard percutaneous nephrolithotomy in the one-stage treatment of caculous pyonephrosis

Objective To explore the safety and efficiency of selective standard percutaneous nephrolithotomy in the one-stage treatment of caculous pyonephrosis.Metdods In 303 Hospital of PLA,146 patients with caculous pyonephrosis were selected from August 2006 to October 2012,who were treated by standard percutaneous nephrolithotomy in the one-stage with EMS Ⅲ LithoClast Master.Meanwhile,anti-infection comprehensive intervention measures were carried out during perioperation.Results The operations of all 146 patients were successful.115 patients received only one operation and 31 patients received secondary surgery.Single standard channel was used in 110 cases,and double standard channels in 36 cases.The peration time ranged from 18 to 69 minutes,mean （43.2±6.7） min.The blood loss ranged from 20 to 96 ml,mean （39±8） ml.There were no serious complications such as nephrectomy,super-selective arterial embolization,shock,the injury of important blood vessels and organ.12 patients with residual stones （the diameter of residual stones were from 0.6 cm to 0.8 cm） were cured by extracorporeal shock wave lithotripsy （ESWL） after operation.The clearance rate of stone was 91.8%,132 patients were followed up from 6 months to 61 months.The renal function returned to some extent in 129 cases.Renal atrophy was observed in 3 cases.Conclusions Color ultrasound guided standard percutaneous nephrolithotomy is a safe and efficient method for the treatment of calculous pyonephrosis.The rate of kidney saving is high.But the patient must be carefully selected and comprehensive intervention measures such as anti-infection must be carried out during perioperative.