摘要
目的探讨双标准通道经皮肾镜取石术结合负压吸引一期治疗鹿角形肾结石并脓肾的安全性、有效性。方法回顾性分析2006年8月至2012年10月应用双标准通道经皮肾镜取石术结合负压吸引装置,治疗的36例鹿角形肾结石并脓肾患者临床资料。患者结石大小(2.8 cm×1.8 cm)^(4.8 cm×2.5 cm),围手术期给予抗感染综合治疗,术中采用EMS三代碎石清石系统先用负压吸引装置吸出肾内脓液,再联合超声气压弹道两种能量碎裂并吸出结石。结果 36例患者均顺利完成手术,一次手术32例,二次手术4例;无肾切除、介入栓塞、感染性休克、大出血以及大血管、胸腹腔脏器损伤等严重并发症。32例患者术后体温正常,3例患者体温37.0~38.5℃,1例患者体温38.5~39℃,均经抗感染治疗1~3 d后体温恢复正常。3例患者残余结石直径≥0.6 cm(0.6~0.8 cm),接受体外冲击波碎石治疗,结石清除率91.7%。34例患者随访6~52个月,2例患者失访;其间32例患者肾功能不同程度恢复,2例患者发生肾脏萎缩。结论选择性双标准通道经皮肾镜取石术联合负压吸引一期治疗鹿角形肾结石并脓肾安全、有效,术中负压吸引有利于降低肾内压力,吸出脓液结合围手术期抗感染综合治疗有助于控制感染。
Objective To discuss the safety and efficiency of selective double standard channel percutaneous nephrolithotomy combined with negative pressure in the one-stage treatment of staghorn caculous pyonephrosis. Methods 36 patients with staghorn caculous pyonephrosis were selected as the objects from August 2006 to October 2012,who were treated by double standard channel percutaneous nephrolithotomy in the one-stage with EMS Ⅲ LithoClast Master. The size of stone mass were(2.8 cm × 1.8 cm)-(4.8 cm×2.5 cm). Anti-infection comprehensive intervention measures were carried out during perioperative. The liquor pus were sucked out by negative pressure system and then the caculous were fragmented and sucked out by ultrasonic and pneumatic lithotripsy at one-stage. Results The operations of 36 patients were successful, 32 patients received only one operation,and 4 patients received secondary surgery. There were no serious complications of nephrectomy,super -selective arterial embolization,shock,the injury of important blood vessels and organ. The temperature of 32 patients were normal after operation,3 cases with 37.0-38.5 ℃, one case was 38.5 -39℃ . The patients who suffered from fever were cured by sensitive bacteriophage. There patients with residual stones (the diameter of residual stones are between 0.6 cm and 0.8 cm)were cured by extracorporeal shock wave lithotripsy (ESWL)after operation. The clearance rate of stone was 91.7%,34 patients were followed up from 6 months to 52 months. The renal function returned to some extent in 32 cases. Renal atrophy was observed in 2 cases. Conclusion Negative pressure system help to reduce the pelvis pressure,sucking out liquor pus and perioperative anti -infection comprehensive intervention measures help to control infection,selective double standard channel percutaneous nephrolithotomy combined with negative pressure in the one-stage is a safe and efficient method for the treatment of selective staghorn calculous pyonephrosis.
出处
《中华腔镜外科杂志（电子版）》
2014年第2期130-134,共5页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
基金
广西壮族自治区卫生厅自筹经费课题(Z2009397
Z2011007
Z2013541)
广西科技攻关计划课题(桂科攻1298003-8-3)
关键词
肾结石
脓肾
经皮肾镜
Renal calculus
Pyonephrosis
Percutaneous nephrolithotomy
