腔内技术治疗上尿路结石合并脓肾的临床研究

Clinical Research of Endoscopic Therapy for Pyonephrosis with Upper Urinary Tract Calculi

目的:探讨腔内泌尿外科技术治疗上尿路结石合并脓肾的方法及疗效。方法:回顾性分析51例上尿路结石合并脓肾患者的临床资料。15例行Ⅰ期经皮肾穿刺造瘘术(Percutaneous nephrostomy,PCN)后Ⅱ期手术,30例行Ⅰ期标准通道PCNL术,6例行经尿道输尿管镜碎石术。结果:所有患者手术顺利,未出现感染性休克、肾动静脉瘘、大出血、胸腹腔脏器损伤等严重并发症。45例随访3个月~2年,40例患肾功能恢复或部分恢复,3例患肾萎缩。结论:腔内泌尿外科技术治疗上尿路结石合并脓肾安全、有效,需根据临床情况(患者全身情况、感染严重程度、结石大小、梗阻部位及程度)选择合适的治疗方法。

Objective：To investigate the mothod and effect of endoscopic therapy for pyonephrosis with upper urinary tract calculi.Methods：The clinical data of 51 cases of pyonephrosis with upper urinary tract calculi were analyzed retrospectively.Percutaneous nephrostomy（PCN）drainage was performed in 15 cases,and then stage Ⅱ operation.30 cases underwent PCNL in stageⅠ.6 cases were treated by transurethral ureteroscopy.Results：All cases finished operation smoothly.There were no serious complications of shock,intrarenal arteriovenous fistula,the injury of important blood vessels and organ.45 cases were followed up from 3 months to 2 years.The renal function returned to some extent in 40 cases,renal atrophy was observed in 3 cases.Conclusion：Endoscopic therapy is safe and effective for the treatment of pyonephrosis with upper urinary tract calculi.Selecting the suitable method depends on the clinical situation（patient general condition,infection severity,calculi size,positon and degree of obstruction）.