标准经皮肾镜联合EMS四代碎石清石系统治疗结石性脓肾的疗效分析

Efficacy analysis of Standard percutaneous nephrolithotomy combined with EMS four generations clear rubble stone system in treatment of calculous pyonephrosis

目的评价标准经皮肾镜联合EMS四代碎石清石系统治疗结石性脓肾的安全性与疗效。方法结石性脓肾患者59例,其中21例Ⅰ期建立24F标准经皮肾通道,在保持低压的状态下行EMS四代超声联合气压弹道碎石、清石治疗;38例先行输尿管镜下留置DJ或经皮肾造瘘引流,再行Ⅱ期标准通道经皮肾镜取石术。结果所有病例均顺利完成手术,未出现大出血、肾周脓肿、脓毒血症及邻近脏器损伤等严重并发症。11例术后出现寒战、高热(>39℃),8例体温在38℃～39℃,其余病例术后体温<38.0℃。术后复查51例结石取净,8例结石残留,结石清除率为86.44%。术后病例随访3～12个月,肾功能恢复或部分恢复54例,肾萎缩5例。结论标准经皮肾镜联合EMS四代碎石清石系统治疗结石性脓肾安全、有效,应根据具体情况选择Ⅰ期或Ⅱ期手术。

Objective To evaluate the safety and clinical efficacy of percutaneous nephrolithotomy combined with EMS four generations clear rubble stone system in treatment of calculus pyonephrosis. Methods 59 cases of calculus pyonephrosis were in research, including 21 cases were established 24F standard percutaneous nephrolithotomy channels inⅠstage, then cleared fester and stone by using EMS four generations ultrasonic and pneumatic cystolithotripsy system under low pressure. And 38 cases had firstly treated by Double-J ureteral stenting with ureterscope or percutaneous nephrostomy,and then operated standard percutaneous nephrolithotripsy inⅡstage. Results The lithotripsy was performed successfully in all patients, and there was no severe complications occurred such as hemorrhoea, perinephric abscess, septicopyemia or injury to the nearby organ. 11 cases had high fever with chills（39℃）, 8 cases＇s body temperature were between 38℃～39℃, the other cases was below 38℃. An review in postoperation, 51 cases＇s stones were cleaned, 8 cases＇s had residual stones,and stone free rate was 86.44%. During the follow-up 3～12 months, the renal function recovery partially in 54 cases, nephrarctia was observed in 5 cases. Conclusion Standard channel percurtaneous nephrolithotripsy combined with EMS four generations ultrasound and pneumatic cystolithotripsy system is a effective, safe way in treating calculus pyonephrosis, and should be designed to do Ⅰ or Ⅱstage treatment based on patient＇s specific conditions.