经皮肾镜取石术治疗肾脏感染性结石的疗效分析(附127例报告)

Application of percutaneous nephrolithotomy combined with the Holmium YAG Laser in treatment of infecton stones(Report of 127cases)

目的：评价经皮肾镜取石术（PCNL）治疗肾脏感染性结石的方法和疗效。方法：对我院2009年1月～2013年6月127例肾感染性结石患者行PCNL的临床资料进行回顾分析,男52例,女75例,结石直径为2～5cm,均为鹿角形或多发性结石。结果：在B超引导下穿刺建立F20～22通道,采用输尿管镜钬激光碎石,105例一次取净结石,平均手术时间为134min,10例结石残余直径〉1cm,1周后经原通道取石,12例结石残余直径〈1cm,选择联合体外冲击波碎石术（ESWL）治疗或药物排石治疗,总住院时间10～17d,平均为13d,1个月后复查KUB,116例未见明显结石残余,结石总清除率91.3%。22例患者术后出现发热,其中8例为寒颤高热（〉39.5℃）,6例为低热（〈38.0℃）,2例为菌血症,1例患者术后出现肾脏持续性出血行栓塞治疗,1例出现尿瘘,未出现脓毒血症、腹腔脏器损伤、腹腔积液、胸腔积液、气胸、肾动静脉瘘等严重并发症发生。结论：通过充分的术前准备,改进术中操作细节,有效的术后护理及抗感染治疗,认为PCNL采用输尿管镜钬激光碎石术具有结石排净率高、创伤小、恢复快、并发症少等优点,是治疗肾脏感染性结石的一种安全有效的方法。

Objective：To evaluate the efficacy and safety of percutaneous nephrolithotomy（PCNL）in the treatment of renal infectious stones with the Holmium YAG Laser.Method：127patients with renal infectious stones who underwent PCNL in our hospital from January 2009to June 2013were retrospectively analyzed.Male52cases,female 75cases,stone size is 2-5cm,all are staghorn or multiple renal calculi.Result：F20-22channels were established under ultrasound guidance,105cases of stone were removed completely,the average operative time was 134min,10patients received a second stage PNCL due to residual stones〉1cm,and 12patients underwent ESWL or medicine due to residual calculi〈1cm.The total stone clearance rate was 91.3%,The total length of hospital stay was 10-17days,13days for averange,116cases had no obvious residual stones one month later,total clearance rate was 91.3%,22patients got postoperative fever,8cases of shiver high fever（〉39.5℃）,6cases of low temperature（〈38.0℃）,2patients developed bacteremia,1patient treated by embolotherapy for persistent renal bleeding,and 1patient got urinary leak,other cases finished operation smoothly.No patients showed urosepsis,abdominal visceral injury,abdominal effusion,pleural effusion,pneumothorax,and renal arteriovenous fistula and other severe complications.Conclusion：PCNL combined with the Holmium YAG Laser is a safe and effective procedure for treating renal infection stones,which has the advantage of less stone residual,injures and complications.