结石性脓肾经皮肾微造瘘后保肾治疗临床观察

Clinical observation of nephron-sparing calculous pyonephrosis with percutaneous micro-nephrostomy

目的探讨运用经皮肾微造瘘保肾治疗结石性脓肾疗效及价值。方法通过对56例行经皮肾微造瘘保肾治疗结石性脓肾患者的临床观察,结合肾动态显像和肾造瘘术后引流量资料进行分析。结果所有患者经皮肾微造瘘引流后病情平稳,56例行二期经皮肾取石术49例(87.5%)结石全部取净,7例(12.5%)留有无意义残石。术后6个月后随访,有功能的患肾46例(82.1%),无功能的患肾10例(17.9%)。术前肾功能轻和中度受损组患肾术后GFR有明显的升高,而肾功能重度受损组术后GFR不升反降。经皮肾造瘘术后造瘘管24h平均引流量小于200mL的患者,无功能肾的发生率高。结论经皮肾微造瘘保肾治疗结石性脓肾是有效的治疗方法,术前肾动态显像显示肾功能的受损程度和肾造瘘术后平均24h引流量是结石性脓肾保肾治疗的重要指标。

【Objective】 To investigate the nephron-sparing feasibility and value of treating calculous py-onephrosis with percutaneous micro-nephrostomy. 【Methods】 the information of renal dynamic imaging and drainage volume of the kidney fistula tube from 56 cases who were treated by nephron-sparing calculous py-onephrosis with percutaneous micro-nephrostomy were clinically observed and analyzed.【Results】The symptoms of all patients were rapidly recovered after treatment with percutaneous micro-nephrostomy. 56 cases were treated by percutaneous nephrolithotomy in the second stage: the urinary calculi was cleared in 49% (49/56) cases, the urinary calculi was residual in 12.5%(7/56) cases. The assessments of therapeutic effect were taken at 6th month after opera-tion,the renal function was comeback in 82.1%(46/56), the renal function was lost in 17.9%(10/56). The GFR was obviously higher in mild and moderately impaired renal function groups than preoperative renal function inspected by renal dynamic imaging. However, the GFR was lower in severe renal impairment groups than preoperative renal function inspected by renal dynamic imaging. The incidence of nonfunctioning kidney was higher in the group than that average postoperative drainage volume of the kidney fistula tube in 24 hours was less than 200 mL. 【Conclu-sions】 Nephron-sparing calculous pyonephrosis with percutaneous micro-nephrostomy are feasible and effective technique; The various degree of impairment of preoperative renal function inspected by renal dynamic imaging and the average postoperative drainage volume of the kidney fistula tube in 24 hours is very important guide line in the nephron-sparing calculous pyoncphrosis.