一期经皮肾镜碎石取石术治疗肾输尿管上段结石合并脓肾的临床分析

The clinical analysis of the first phase percutaneous nephrolithotomy in the treatment of renal and upper ureteral calculi complicated with pyonephrosis

目的 探讨一期经皮肾镜碎石取石术（percutaneous nephrolithotomy,PCNL）治疗肾输尿管上段结石合并脓肾的疗效.方法 回顾性分析本院近1年来42例一期PCNL术治疗肾输尿管上段结石合并脓肾患者（观察组）以及40例行二期PCNL术患者（对照组）的临床及随访资料,比较两组患者的手术时间、住院时间、住院费用、结石清除率、严重并发症（发热、中度以上贫血、感染性休克等）发生率等指标.结果 观察组患者手术时间、住院时间、住院费用均明显低于对照组患者（P＜0.05）,两组患者结石清除率及术后并发症发生率比较无明显差异（P＞0.05）.结论 若能具备围手术期充分的评估、恰当的药物诊治及娴熟的手术操作,一期PCNL术治疗肾输尿管上段结石导致的脓肾是经济、安全、有效的,具备临床推广价值.

Objective To explore the curative effect of the first phase percutaneous nephrolithotomy in the treatment of renal and upper ureteral calculi complicated with pyonephrosis.Methods A total of 42 cases with renal and upper ureteral calculi were treated with the first phase percutaneous nephrolithotomy （experimental group） and 40 cases with renal and upper ureteral calculi were treated with the first phase percutaneous nephrolithotomy （control group）.Clinical data of two groups,which came from our hospital the last one year,were analyzed retrospectively.The time of operation,the duration of hospital stays,the hospitalization expenses,the success rate of lithotripsy,and complication incidence of the two groups were conpared,such as fever,moderate anemia,septic shock and so on.Results The time of operation,the duration of hospital stays,the hospitalization expenses in the experimental group were lower than that in the control group （P ＜ 0.05）.There was no significant statistical difference in the success rate of lithotripsy and complication incidence between two groups （P ＞ 0.05）.Conclusions If there are sufficient perioperative assessment,the appropriate diagnosis and treatment of drug,skilled operation,the first phase percutaneous nephrolithotomy in the treatment of renal and upper ureteral calculi complicated with pyonephrosis will be a secure,effective,economical procedure and worthy of popularization.