二期手术处理33例输尿管上段结石合并肾积脓

The experience of two-stage PCNL in the treatment of upper ureteral calculi associated with ipsilateral pyonephrosis

目的探讨二期经皮肾镜取石术处理输尿管上段结石合并同侧。肾积脓的围手术期处理要点。方法回顾分析我院收治的33例输尿管上段结石合并肾积脓患者的临床资料，所有患者均采用一期经皮。肾穿刺造瘘配合抗感染治疗，待引流液变清、炎症症状消失及实验室指标好转后3～5d行二期经瘘道输尿管镜下钬激光碎石取石术，术中常规留置输尿管内支架引流及肾造瘘管，观察手术的效果及并发症。结果所有手术均取得成功，无大出血、水中毒、菌血症等并发症发生；33例术后复查无明显结石残留；随访3～12个月，1例肾功能无法恢复，行患肾切除术，其余患。肾功能得到不同程度恢复。结论早期诊断上段结石合并肾积脓是治疗成功的关键，积极有效的。肾造瘘引流并适时行二期碎石取石可减少手术并发症的发生，同时可有效的保护患肾功能。

Objective To investigate the feasibility and efficacy of two-stage minimally invasive percutaneous nephrolithotomy （mPCNL） in treating upper ureteral calculi associated with ipsilateral pyonephrosis. Methods The clinical data of 33 patients with upper ureteral calculi and ipsilateral pyonephrosis were analyzed retrospectively. All patients underwent one-stage percutaneous nephrostomy combined with anti-infection therapy. Two-stage mPCNL was performed 3-5 days after drainage fluids become clear, inflammation symptoms disappeared and laboratory indicators improved. Double-J stent and renal fistula were placed after the operation routinely. Therapy effect and complications were observed and analyzed. Results All the procedures were successful. No massive hemorrhage, water intoxication, bacteremia and other complications occurred during operation. No obvious residual stones on postoperative re-exam was fourd in all patients. Only one case did not recover in renal function after 3-12 months follow-up and had to be nephrectomize, others had renal function recovery partially in different degree. Conclusions Early diagnosis of upper ureteral calculi associated with ipsilateral pyonephrosis is the keys of successful treatments. Effective nephrostomy drainage and two-stage mPCNL timely may decrease incidence of complications.