腔镜技术治疗结石性脓肾54例临床分析

Clinical analysis of 54 cases of laparoscopic technique in the treatment of calculous pyonephrosis

目的 通过临床观察腔镜技术治疗结石性脓肾患者,分析其治疗效果.方法 回顾性分析本院54例结石性脓肾患者资料,其中18例分别行1期经皮肾镜取石术,24例先行1期经皮肾穿刺造瘘引流术后再行2期经皮肾镜碎石术,12例先经尿道膀胱镜下逆行留置D-J管后2期行经皮肾镜碎石术或输尿管镜碎石术治疗.结果 54例患者行1期手术者18例,结石取净者17例,取净率94.44％,残余结石者1例,出现并发症1例;行2期手术者36例,结石取净者30例,取净率83.33％,结石残留者6例,出现并发症8例.术后获得随访者40例,时间为6 -12个月,经B超、造影检查,大部分患者肾功能基本得到恢复,无其他并发症.结论 采用腔镜技术治疗结石性脓肾疗效满意,结石排净率高,并发症少,1期和2期取石率比较,差异性不大,但临床应根据患者实际情况来选择1期或是2期手术.

Objectives To observe the clinical endoscopic technique in the treatment of patients with calculous pyonephrosis,and analyze the therapeutic effects.Methods Respectively analysis of 54 cases with calculous pyonephrosis.Among them,18 cases received 1 stage pereutaneous nephrolithotomy,24 cases 2 stage percutaneous nephrolithotomy after 1 stage percutaneous nephrostomy drainage and 12 cases transurethral resection of bladder endoscopic retrograde phase 2line D-J tube indwelling after percutaneous nephrolithotomy or ureteroscopic lithotripsy for the treatment.Results 54 cases have received surgical intervention,17/18 cases who got one-stage operation were removed completely and the final stone-free rate was 94.4%.Only one had complications in the 18 cases.30/36 cases who got 2-stage operation were removed completely and the stone-free rate was 83.33%.Among 36cases,6 cases had residual stones,and 8 cases had complications.We successfully followed up 40 cases,with the time ranging from 6 to 12 months,B ultrasound or angiography showed that the renal function of majority has recovered to normal and no complication has been found.Conclusions The curative effect of laparoscopic technique in the treatment of calculous pyonephrosis,with high lithagogue rate and less complications,is of satisfaction,There is no significant difference in stone-free rate between one-stage operation and two-stage operation.The choice of surgical approach depends on the actual situation of patients.