经皮肾镜输尿管镜气压弹道超声联合治疗结石性脓肾

Treatment for calculous pyonephrosis with percutaneous nephrolithotipsy and ureterorenoscope lithotripsy

目的探讨结石性脓肾的治疗方法和疗效。方法对26例结石性脓肾患者,20例采用经皮肾镜气压弹道超声Ⅰ期碎取石术,6例采用经尿道输尿管镜碎取石术治疗。结果20例患者Ⅰ期经皮肾镜结石取净率90%(18/20),2例术后补充ESWL治愈。术后6个月以上随访22例,患肾功能恢复或部分恢复18例(69.2%),患肾萎缩(无功能)3例(11.5%),患肾切除1例(3.8%)。结论经皮肾镜输尿管镜气压弹道超声联合Ⅰ期治疗结石性脓肾,安全、有效,明显缩短患者治疗时间,减轻患者负担,具有创伤小,可有效提高结石性脓肾保肾治疗率。

Objective To investgate the efficiency and methods of calculous pyonephrosis by percutaneous nephrolithotripsy（PCNL）and ureterorenoscope lithotripsy.Methods 26 cases of calculous pyonephrosis,percutaneous nephrolithotripsy were administered to 20 cases and ureterorenoscope lithotripsy were administered to 6 cases,all including first stage treatment.Results The rate of percutaneous nephrolithotripsy,18 cases achieved stone-free（90%）,and 2 cases with residual calculi were treated by ESWL.The renal function returned to some extent in 18 cases（69.2%）.Renal atrophy was observed in 3 cases（11.5%）,only 1 case（3.8%）need nephrecomy.Conclusion In first stage PCNL and ureterorenoscope lithotripsy are safe and efficient methods for the treatment of calculous pyonephrosis,are effective clinically with advantage of minimal invasive,high success ratio,quik recovery and short period in hospital.The rate of kidney saving is very high.