经皮肾穿刺造瘘在梗阻性肾积水(脓)中的临床价值

Clinical Value of Percutaneous Nephrostomy in the Diagnosis and Treatment of Obstructive Hydronephrosis and Pyonephrosis

目的:探讨经皮肾穿刺造瘘(PCN)在梗阻性肾积水(脓)中的临床应用价值。方法:对86例肾积水(脓)患者先行超声引导经皮肾穿刺造瘘引流,待肾功能改善、机体状况好转或经引流及造影确定诊断,其中结石引起的肾积水(脓)69例,非结石性肾积水(脓)17例,合并脓肾31例。52例行经皮肾镜取石碎石术,17例行后腹腔镜肾盂、输尿管切开取石术,6例行肾盂切开取石术后加行肾盂输尿管成型术;5例行输尿管狭窄段切除端端吻合术;3例行肾下盏-输尿管吻合术;3例行输尿管皮肤造瘘术。结果:86例患者均穿刺成功,及时解除梗阻,71例患者肾功能恢复正常;9例肾功能改善,维持在轻中度氮质血症水平;6例肾功能无改善。结论:PCN所建立的通道为缓解病情、病因诊断和二期手术打开方便之门,尤其是对急性梗阻性脓肾及结石梗阻性肾积水(脓)的诊治具有重要的应用价值。

Objective：To study the value of percutaneous nephrostomy （PCN） in the treatment of obstructive hydronephrosis and pyonephrosis. Methods： 86 cases of hydronephrosis and pyonephrosis were underwent PCN before completely treatment for relieving of obstruction until the kidney function improved, body condition improved or drainage and angiography confirmed the diagnosis, which caused by kidney stones in water （septic） 69 cases Non-calculous hydronephrosis （pus） in 17 cases, 31 cases of combined kidney abscess. 52 cases received percuta neous nephrolithotomy stone lithotripsy, 17 cases received Laparoscopic renal pelvis, ureter surgery, 6 cases received renal pelvis after fetching additional line of pelvis and ureter stones forming operation; 5 cases received ure teral stricture resection and anastomosis,3 cases received Under the lamp-renal ureteral anastomosis, 3 cases received ureteral skin fistulization. Results： 86 cases were punctured successfully and timely relieve obstruction, 71 patients back to normal renal function; nine cases had improved renal function, and maintained at the level of mild to moderate azotemia; six cases of renal function were not improved. Conclusions： PCN is effective and safe in the diagnosis and treatment of obstructive hydronephrosis（pyonephrosis）, especially in calculus obstruction and acute pyonephrosis.