肾造瘘后Ⅱ期与Ⅰ期经皮肾镜取石术治疗结石感染性肾积水的疗效比较

Comparison of clinical efficacy between one-stage PCNL and second-stage PCNL after nephrostomy for the treatment of stone infected hydronephrosis

目的：探讨经皮肾镜取石术（PCNL）治疗结石感染性肾积水的临床疗效与分期手术选择。方法：回顾性分析2011年1月～2013年10月采用PCNL治疗65例结石感染性肾积水患者的临床资料,37例Ⅰ期肾造瘘引流后再Ⅱ期行PCNL（A组）,28例Ⅰ期行PCNL（B组）。比较两组手术时间、术中出血量、并发症发生率、结石清除率及住院时间等。结果：A组PCNL术中出血量、PCNL术后住院时间、并发症发生率明显少于B组（P〈0.05）,分别为（55.2±9.4）ml vs（97.3±13.6）ml、（6.4±1.5）d vs（10.5±2.7）d、10.8%vs 46.4%,A组一期结石清除率高于B组,为89.2%vs 78.6%（P〈0.05）。结论：Ⅰ期肾造瘘引流后再Ⅱ期行PCNL治疗结石感染性肾积水安全、有效;Ⅰ期PCNL治疗结石感染性肾积水需谨慎选择。

Objective： To investigate the clinical efficacy and staging strategy of percutaneous nephrolithotomy （PCNL） for upper urinary calculi complicated with infected hydronephrosis. Method： Clinical data of 65 patients with stone infected hydronephrosis by PCNL from January 2011 to October 2013 were retrospectively analyzed. Thirty-seven patients were treated by one-stage percutaneous nephrostomy and second-stage PCNL （group A）, while 28 patients were treated by one-satge PCNL （group B）. The operative time, intraoperative blood loss, the stone free rate, complication incidence rate and hospital stay were compared between the two groups. Result： The intraoperative blood loss was less in group A （55.2±9.4） ml vs （97.3±13.6） ml, P 〈0. 052, and postopera- tive hospital stay of group A was shorter than that of group B （6.4±1.5） d vs （10.5±2.7） d, P〈0. 052. The complication incidence rate was lower in group A （10.8% vs 46.4%, P 〈0.05）. The stone free rate was higher in group A （89.2% vs 78.6M, P 〈0.05）. Conclusion： The strategy of one-stage percutaneous nephrostomy and second-stage PCNL is safe and effective for the treatment of stone infected hydronephrosis. However, one-stage PCNL for upper urinary calculi complicated with infected hydronephrosis should be selected carefully.