复杂上尿路结石合并脓肾腔内技术治疗体会.docVIP

复杂上尿路结石合并脓肾腔内技术治疗体会 　 作者：苏海龙，冯仲信，白忠宏 【摘要】 目的：探讨腔内技术治疗复杂上尿路结石合并脓肾的安全性和有效性。方法: 选择2002年11月～2007年7月复杂上尿路结石合并脓肾患者37例, 采用经尿道输尿管镜取石后置管内引流8例，微创经皮肾造瘘外引流29例，术后7～14 d后，2期行微创经皮肾镜治疗复杂肾结石。结果：1期内、外引流术中均未出现败血症、感染性休克症状，2期行微创经皮肾镜术中出现寒战、发热等菌血症状者2例（5.4%），术中及术后均无大出血和感染性休克症状，残留结石8例(21.6%)。31例随访3个月～1年, 27例(87.1%)患肾功能均有不同程度的恢复，患肾萎缩（无功能）2例(6.5%)，患肾肾盂肾炎2例（6.5%），其中患肾切除1例（3.2%）。结论：采用腔内技术治疗复杂上尿路结石合并脓肾，是一种比较安全、并发症较少、较好保护肾功能的治疗方法。 【关键词】 尿路结石；脓肾；腔内技术 ［ABSTRACT］ Objective: To explore the safety and efficiency of intracavitary therapy for complex upper urinary lithangiuria with pyonephrosis. Methods: 37 patients with complex upper urinary lithangiuria with pyonephrosis were selected during November 2002 to July 2007. 8 cases were treated with transurethral ureteroscope lithotripsy followed by tube internal drainage, while 29 cases were treated with minimally invasive percutaneous nephrolithotomy. After 714 days, minimally invasive percutaneous nephrolithotomy was employed for the second therapy. Result: No complications as septicemia and septic shock occurred during the first stage of external drainage. Bacteremia symptoms as chill, fever occurred in 2 cases during the second stage of minimally invasive percutaneous nephrolithotomy (5.4%), while no massive hemorrhage and septic shock occurred during and after surgery. 8 cases had residual stones (21.6%). Followup for 312 moths showed that renal function recovered to different degree in 27 out of 31 cases (87.1%), 2 cases had atrophy kidney (6.5%), and 2 cases had pyelonephritis (6.5%), one of whom had nephrectomy (3.2%). Conclusion: Application of endoscopic technology in the treatment of complex upper urinary lithangiuria with pyonephrosis is safe and with little complication. It can protect renal function. ［KEY WORDS］ Urinary lithangiuria; Pyonephrosis; Endoscopic technology 对于结石性脓肾，直到20世纪80年代早期，肾切除术仍是结石性脓肾的主要治疗方法［1］，而复杂上尿路结石合并脓肾的患肾切除率更高。随着泌尿外科腔内技术的发展，采用腔内技术治疗复杂上尿路结石合并脓肾的安全性和有无保肾价值，一直存有争议。2002年11月～2007年7月，我院对37例复杂上尿路结石合并脓肾应用腔