负压吸引在脓肾患者二期经皮肾镜取石术中的应用

Application of negative pressure suction in the second stage percutaneous nephrolithotomy in patients with pyonephrosis

目的探讨负压吸引在脓肾患者二期经皮肾镜取石术(PCNL)中的应用价值。方法选取2009年10月至2017年8月我院70例合并脓肾的上尿路结石患者,均先采用造瘘引流脓液并使用敏感抗生素或经验性使用抗生素,后行二期PCNL术,依据结石最大直径与结石类型分为负压吸引组(n=36)和常规组(n=34),记录两组手术一般资料,对比两组手术前后血清尿素氮(BUN)、血肌酐(SCr)及C反应蛋白(CRP)、降钙素原(PCT)水平,并记录两组结石清除率、术后并发症发生率。结果负压吸引组手术时间、住院时间、术中出血量均少于常规组(P<0.05);两组术后血清BUN、SCr、CRP、PCT水平均高于术前,且负压吸引组上述指标升高幅度小于常规组(P<0.05);负压吸引组结石清除率高于常规组(P<0.05);两组术后2周并发症总发生率差异无统计学意义(P>0.05),但负压吸引组术后发热发生率低于常规组(P<0.05)。结论负压吸引应用于脓肾患者二期PCNL术中,具有安全、有效、结石清除率高等优势,且能减少对患者肾功能的影响,降低炎症水平及发热发生率,值得在临床推广应用。

To explore the application value of negative pressure suction in the second stage percutaneous nephrolithotomy(PCNL)in patients with pyonephrosis.Seventy patients with urinary tract stones combined with pyonephrosis treated in our hospital from October 2009 to August 2017 were selected for the study.They were first treated with colostomy drainage and sensitive antibiotics or empirical use of antibiotics.Then,they underwent the second stage PCNL.According to the maximum diameter of stones and the types of stones,the patients were randomly divided into the negative pressure suction group(n=36)and the conventional group(n=34).The general information of the two groups was recorded,and the levels of serum urea nitrogen(BUN),serum creatinine(SCr),C reactive protein(CRP)and procalcitonin(PCT)were compared before and after operation.The stone clearance rate and incidence of postoperative complications were compared between the two groups.The operative time,the hospital stay and the intraoperative blood loss in the negative pressure suction group were shorter or lower than those in the conventional group(P<0.05).The levels of postoperative serum BUN,SCr,CRP and PCT were significantly higher than those in before operation in the both groups(P<0.05),and the increasing degree of the above indexes in the negative pressure suction group was smaller than that in the conventional group(P<0.05).The stone clearance rate of the negative pressure suction group was higher than that of the conventional group(P<0.05).There was no significant difference in the total incidence of complications at 2 weeks after operation between the two groups(P>0.05),but the incidence of postoperative fever in the negative pressure suction group was lower than that in the conventional group(P<0.05).The negative pressure suction has the advantages of high safety and effectiveness and high stone clearance rate in the second stage PCNL of patients with pyonephrosis.It can reduce the influence on renal function and the inflammation level as well as the incidence of fever.Therefore,it is worthy of clinical promotion and application.