泌尿外科腔镜技术治疗结石性脓肾

Urinary surgery endoscopic techniques in the treatment calculous pyonephrosis

目的:探讨运用腔内泌尿外科技术治疗结石性脓肾的安全性和有效性。方法:78例结石性脓肾患者中,4例行Ⅰ期脓肾切除术,53例行Ⅰ期内腔镜手术(21例行Ⅰ期经尿道输尿管镜取石术,32例行Ⅰ期微创经皮肾镜取石术),21例行Ⅱ期手术,即Ⅰ期经皮肾微造瘘引流、Ⅱ期腔内技术取石术(18例)或肾切除术(3例)。碎石术采用气压弹道治疗19例,钬激光治疗52例。结果:71例内镜取石术中63例(88.7%)结石被取净,8例行肾切除术,无术后大出血、感染性休克、脓肿播散等严重并发症;37例随访1～12个月,29例(78.4%)肾功能得到不同程度恢复,8例(21.6%)患肾萎缩(无功能)。结论:采用腔内泌尿外科技术(尤其是结合钬激光技术)治疗结石性脓肾安全、有效,保肾率高,可作为结石性脓肾的首选治疗方法;应根据具体情况选择Ⅰ期或Ⅱ期手术。

Objective： To investigate the safety and efficacy of surgical endoscopic techniques in treating calculous pyonephrosis. Methods： 78 patients with calculous pyonephrosis were involved, of 4 patients with pyonephrosis were taken stage Ⅰ nephrectomy, of 53 patients were underwent stage Ⅰendoscopic surgery （21 cases were gave calculus removed by trans-urethral ureteroscope, 32 cases were done percutaneous nephrolithotripsy）, of 21 patients were stage Ⅱ operation including stage Ⅰ percutaneous renal micro-fistulation, stage Ⅱ stone extraction with endoscope in 18 or nephrectomy in 3 cases. 19 patients were treated by pneumatic ballistic lithotripsy, 52 cases by holmium laser therapy. Results： 63 of 71 patients treated by endoscopic stone extraction technique were satisfied with no remained stones, of 8 were nephrectomy. Postoperatively, there were no severe complications such as bleeding and septic shock and abscess scattering. All patients were followed up 1 -12 months, of 29 （78.4%）had renal function recovery partially, of 8 had renal atrophy （21.6%）. Conclusions： Urinary surgical endoscopic techniques （especially combined holmium laser therapy） are safe and effective with prefer renal recovery rate. It can be the first choice for calculous pyonephrosis, but specific consideration should be made for each individual.