摘要
目的:探讨一期肾造瘘后二期于斜仰卧截石位下肾镜联合输尿管软镜同期治疗伴有肾积脓的复杂型肾结石的临床应用和疗效。方法:对2016年1月—2021年6月46例结石梗阻性肾积水感染后形成肾积脓的复杂型肾结石患者,一期于彩超引导下行经皮肾穿刺造瘘引流,感染控制后,二期同时行肾镜联合输尿管软镜钬激光碎石取石术。分析结石清除情况及相关并发症发生情况。结果:46例患者均成功完成手术,无周边脏器损伤、尿脓毒症、术后出血、死亡等严重并发症发生。除体位摆放时间外,平均手术时间(55.58±14.37)min。术后住院天数(8.50±2.11)d。术后无一例患者需接受输血治疗,有2例出现发热,6例结石残留。结石一次完全清除率达86.96%。结论:对合并结石梗阻性肾积脓的复杂型肾结石,一期肾穿刺造瘘引流是治疗成功的关键,可以提高后续治疗的安全性。在安全的基础上,二期同时行经皮肾镜联合输尿管软镜钬激光碎石取石术,可以明显提高结石的清除率,临床效果显著、创伤小、术后恢复好,对肾积脓性复杂型肾结石的治疗有重要意义。
Objective:To investigate the clinical application and effectiveness of one-stage nephrostomy and subsequent two-stage simultaneous percutaneous nephrolithotripsy combined with flexible ureteroscopic lithotripsy in the oblique supine lithotomy position for complex renal calculi with obstructive calculous pyonephrosis.Methods:From January 2016to June 2021,one-stage percutaneous nephrostomy guided by ultrasonography were performed on 46patients with complex renal calculi with pyonephrosis secondary to calculous obstructive infectious hydronephrosis.After the infection was controlled,two-stage simultaneous percutaneous nephrolithotripsy combined with flexible ureteroscopic lithotripsy in the oblique supine lithotomy position were performed.Stone clearance rate as well as relevant complications were observed retrospectively.Results:All 46operations were performed successfully.None of the serious relevant complications such as splanchnic injuries,urosepsis,postoperative hemorrhage or deaths were observed.Excluding patient positioning time,mean operative time was(55.58±14.37)minutes.Postoperative hospital stay was(8.50±2.11)days.After the operation,no patient needed blood transfusion.Two patients had fever and 6patients were examined with residual stone.One-step stone-free rate amounts to 86.96%.Conclusion:One-stage nephrostomy is the key to successful treatment for complex calculi with calculous obstructive pyonephrosis.It provides safety for subsequent treatment.On the basis of safety,subsequent two-stage simultaneous percutaneous nephrolithotripsy combined with flexible ureteroscopic lithotripsy in the oblique supine lithotomy position improves initial stone-free rate for complex renal calculi with pyonephrosis secondary to calculous obstructive infectious hydronephrosis,with considerable clinical effect,minor surgical trauma and preferred postoperative recovery.It attaches great significance to the treatment of complex calculi with pyonephrosis.
作者
杨正平
杨关天
杨建军
胡向农
YANG Zhengping;YANG Guantian;YANG Jianjun;HU Xiangnong(Department of Urology,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing,210028,China;Department of Urology,Jiangsu Province Hospital of Integration of Chinese and Western Medicine)
出处
《临床泌尿外科杂志》
CAS
2022年第4期273-277,共5页
Journal of Clinical Urology
关键词
肾积脓
肾结石
肾造瘘
经皮肾镜
输尿管软镜
pyonephrosis
renal calculi
nephrostomy
percutaneous nephroscope
flexible ureteroscope
