标准通道PCNL一期治疗结石性脓肾的安全与疗效评价

Safety and Efficacy Evaluation of One Phase Treatment of Renal Calculi Accompanied with Pyonephrosis by Standard Tunnel-percutaneous Nephrolithotripsy

目的:探讨标准通道PCNL一期治疗结石性脓肾的安全性和治疗效果。方法:对38例结石性脓肾患者在B超定位下穿刺、扩张,建立标准通道,应用EMS三代超声弹道碎石清石系统配合负压吸引装置碎石清石及吸出脓液。结果:32例结石完全取净,残留结石6例;经肾造瘘通道取净3例,残余结石术后1个月行ESWL治疗1～2次,结石完全排净。住院时间15～21天,平均1 6.7天。未出现菌血症、脓血症、感染性休克、肾周脓肿、大出血等严重并发症。全部病例随访1～36个月,无继发性肾积脓或肾功能损害等并发症。结论:采用标准通道PCNL治疗结石性脓肾安全、有效,可作为一期治疗结石性脓肾的首选方法。

Objective：To evaluate the clinical efficacy and safety of one phase treatment of renal calculi associated with pyonephrosis hy percutaneous nephrolithotripsy（PCNL）. Methods： 38 cases of renal calculi accompanied with pyonephrosis were treated with PCNL. The renal calyx was punctured under ultrasound guidance, then the tract was dilated by peel-away vascular access sheathes, and standard tunnels were built. EMS III Litho Clast Master was used. Ultrasonic powered lithotriptor probe was used to clear the liquor purls and calculus fragments. Results：One phase PCNL was successfully completed in 32 cases. Other 6 cases were residual stone. Of the 6 ca- ses,the residual stones of 3 cases were pellated by nephros-stoma tunnels, and the others were received ESWL after 1 month of the operation. All the calculi were eliminated. The lengths of stay were 15-20 days, and average 16.7 days. There was no serious complication, such as baeteremia, pyaemia, septic shock, paranephric abscess or hemorrhea. After follow up visit 1 36 months, all patients were no complication occurred, for example continue pyonephrosis or renal functional damage. Conclusions： Application of PCNL in the treatment of patients with renal calculi accompanied with pyonephrosis is safe and clinically efficient by pneumatic combined with ultrasonic lithotriptor. It may be a first selection for treatment.