B超引导下肾穿刺引流二期经皮肾镜取石术治疗结石性脓肾临床观察

Clinical analysis of 28 cases of calculous pyonephrosis undergoing B-ultrasound-guided renal puncture and drainage followed by secondary percutaneous nephrolithotomy

目的 探讨B超引导下肾穿刺引流,二期经皮肾镜取石术(PCNL)治疗结石性脓肾的疗效.方法 收集2014年1月至2018年4月复旦大学附属第五人民医院泌尿外科收治的28例输尿管上段、肾结石伴有脓肾的患者,所有患者均一期在B超引导下行肾穿刺引流脓液,待炎症控制、临床情况好转后二期行PCNL治疗,术中常规留置输尿管内支架引流及肾造瘘管,观察手术的效果及并发症.结果 28例均穿刺成功,解除梗阻,炎症得到控制.二期PCNL手术顺利,术后复查无明显结石残留,未出现严重全身炎症反应综合征、严重出血等并发症.随访3~12个月,患肾功能得到不同程度恢复,无肾功能衰竭而行肾切除患者.结论 早期诊断结石合并脓肾是治疗成功的关键,积极有效的B超引导下肾穿刺引流,引流脓液,解除尿路梗阻,可以提高二期PCNL碎石的安全性,对结石性脓肾治疗有重要意义.

Objective To investigate the therapeutic effects of first phase renal puncture and drainage guided by B ultrasound and second phase percutaneous nephrolithotomy(PCNL) in the treatment of urinary calculi complicated with pyonephrosis. Methods From January 2014 to April 2018, 28 patients with upper ureteral segment and kidney calculi complicated with pyonephrosis were collected. All patients received the pyonephrosis puncture under B ultrasound. After the inflammation was controlled and the clinical situation improved, the second phase was treated by PCNL. During the operation, routine in dwelling ureteral stent drainage and renal fistula wereperformed. The outcomes of the operation were observed. Results A total of 28 cases were successfully punctured, the obstruction was relieved and the inflammation was controlled. Additionally, the second phase of PCNL surgery was successful, and there were no significant stone residues after PCNL. There were no complications such as severe systemic inflammatory response syndrome and severe hemorrhage. After 3 to 12 months of follow-up, renal function was restored to varying degrees, and there were no renal failure patients who needednephrectomy.Conclusions Early diagnosis of urinary calculi complicated with pyonephrosis is the key to successful treatment. Active and effective B ultrasound-guided renal puncture and drainage, drainage of pus, and removal of urinary obstruction can improve the safety of the second phase of PCNL, and thus it attaches great importance to the treatment of pyonephrosis.