二期微创经皮肾镜取石术治疗上尿路结石并感染

Two-stage minimally invasive percutaneous nephrolithotomy in the treatment of upper urinary calculi associated with infection

目的探讨二期微创经皮肾镜取石术(MPCNL)治疗上尿路结石并感染的方法与临床效果。方法回顾性分析208例采用MPCNL治疗的上尿路结石并感染患者的临床资料。208例患者均一期行经皮肾穿刺造瘘,二期行经皮肾镜取石术。单通道取石179例,双通道取石29例。1次取石150例,2次取石52例,3次取石6例。结果本组结石清除率98.1%(204/208),平均取石时间110min,术中平均出血30ml,均未输血。平均住院14天。9例术后出现高热(>39℃),其余未见严重并发症。结论二期MPCNL对于治疗合并感染的上尿路结石安全有效,尤其对结石合并脓肾、梗阻性肾功能衰竭等全身状况较差的患者,二期手术可作为首选。

Objective To investigate the feasibility and efficacy of two-stage minimally invasive percutaneous nephrolithotomy（MPCNL） in treating upper urinary calculi associated with urinary tract infection.Methods The data of 208 patients with upper urinary calculi and urinary tract infection received two-stage MPCNL were analyzed retrospectively.All of the 208 cases underwent one-stage percutaneous nephrostomy,and then two-stage MPCNL.The procedure was performed by single tract in 179 cases,and by two tracts in 29 cases.Lithotomy was done by one time in 150 cases,by two times in 52 cases,and by three times in 6 cases.Results In the group the total stone clearance rate was 98.1%.The mean operative time was 110min,average volume of blood loss was 30 ml,and mean hospitalization was 14 days.There were no severe complications except 9 cases with high fever（39℃） postoperatively.Conclusions Two-stage MPCNL is safe and effective in treating upper urinary calculi associated with urinary tract infection,especially for patients associated with pyonephrosis,obstructive renal failure and so on.