经皮肾镜输尿管镜气压弹道超声联合治疗结石性脓肾
【摘要】 目的 探讨结石性脓肾的治疗方法和疗效。方法 对26例结石性脓肾患者，20例采用经皮肾镜气压弹道超声Ⅰ期碎取石术，6例采用经尿道输尿管镜碎取石术治疗。结果 20例患者Ⅰ期经皮肾镜结石取净率90%(18/20)，2例术后补充ESWL治愈。术后6个月以上随访22例，患肾功能恢复或部分恢复18例(69．2%),患肾萎缩(无功能)3例(11．5%)，患肾切除1例(3．8%)。结论 经皮肾镜输尿管镜气压弹道超声联合Ⅰ期治疗结石性脓肾，安全、有效，明显缩短患者治疗时间，减轻患者负担，具有创伤小，可有效提高结石性脓肾保肾治疗率。
【Abstract】 Objective To investgate the efficiency and methods of calculous pyonephrosis by percutaneous nephrolithotripsy(PCNL)and ureterorenoscope lithotripsy.Methods 26 cases of calculous pyonephrosis,percutaneous nephrolithotripsy were administered to 20 cases and ureterorenoscope lithotripsy were administered to 6 cases，all including first stage treatment.Results The rate of percutaneous nephrolithotripsy，18 cases achieved stone-free(90%)，and 2 cases with residual calculi were treated by ESWL.The renal function returned to some extent in 18 cases(69．2%).Renal atrophy was observed in 3 cases(11．5%),only 1 case(3．8%)need nephrecomy.Conclusion In first stage PCNL and ureterorenoscope lithotripsy are safe and efficient methods for the treatment of calculous pyonephrosis，are effective clinically with advantage of minimal invasive，high success ratio，quik recovery and short period in hospital.The rate of kidney saving is very high.
【Key words】Percutaneous nephrolithotripsy and ureterorenoscope lithotripsy；Urinary tract calculi；Pyonephrosis
本院自2005年11月至2008年2月，共收治结石性脓肾26例，均行Ⅰ期经皮肾镜气压弹道超声联合碎石术或经尿道输尿管镜取石术治疗，效果确切，现报告如下。
1 资料与方法
1．1 临床资料 本组26例患者，男11例，女15例；年龄21~65岁，平均39岁。右侧肾结石13例，输尿管结石3例；左侧肾结石8例，输尿管结石2例。发病时间7 d~3年，平均4个月。既往有尿结石史12例，行过ESWL治疗史5例。均有不同程度的患侧腰痛，反复肾绞痛者11例，曾有肉眼血尿并骨绞痛9例，发热10例，均有不同程度消瘦、贫血。体检:均有患侧肾区叩痛及深压痛。血生化检查:血WBC升高者24例，肾功能不全2例；尿常规:WBC阳性21例。IVU及B超示肾结石20例，输尿管结石6例；B超或CT均提示患肾中、重度积液，肾实质变薄；IVU患肾均不显影。同位素肾图均为梗阻型肾图，患肾功能轻至中重度损害。
1．2 材料及设备 小狮王牌B超，EMS第三代气压弹道超声碎石仪器及筋膜扩张器等相应配套设施，WolfF30经皮肾镜及F8．0/9．8输尿管镜，0．0889 cm(0．035英寸)Boston斑马导丝等。
1．3 治疗方法 本组26例患者，均术前积极有效广谱抗生素或敏感抗生素