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目的:评估标准通道经皮肾镜取石术结合负压吸引治疗合并脓肾的多发性肾结石的安全性及有效性。方法:回顾性分析2009年10月～2012年2月期间收治的11例合并脓肾的多发性肾结石患者临床资料:主要结石大小(2.0cm×2.5cm)～(7.0cm×3.5cm)。2例术前中段尿培养阳性;术中穿刺后均明确诊断合并脓肾。11例均采用标准通道经皮肾镜取石术进行治疗,同时连接负压吸引,患侧上尿路置入F5输尿管导管持续引流脓液。其中Ⅰ期行肾造瘘3例,碎石8例,Ⅱ期手术9例,Ⅲ期手术2例。结果:Ⅰ期手术时间15～70min,平均47min。出血50～200ml,平均约100ml,未输血,无泌尿道严重损伤、周围脏器损伤等并发症。术后未出现严重出血、肾周脓肿、感染性休克。术后发热4例,选择敏感抗生素或广谱抗生素加强抗感染及支持治疗后症状消失。2例残余少许结石,行ESWL治疗。结石清除率为81.8%(9/11)。结论:采用标准通道超声碎石结合负压吸引并分期手术治疗合并脓肾的多发性肾结石,可充分引流脓液,控制感染,快速清除结石,同时避免了严重并发症,临床安全、有效。
OBJECTIVE: To evaluate the safety and efficacy of standard percutaneous nephrolithotomy combined with vacuum suction in the treatment of multiple nephrolithiasis with pus. Methods: The clinical data of 11 patients with multiple nephrolithiasis complicated with purulent kidney admitted from October 2009 to February 2012 were retrospectively analyzed. The main stone size was 2.0cm × 2.5cm ~ 7.0cm × 3.5cm. 2 cases of preoperative urine culture positive; puncture after surgery were clearly diagnosed with purulent kidney. All the 11 cases were treated by standard channel percutaneous nephrolithotomy, while negative suction was connected. The upper urinary tract was placed in F5 ureteral catheter for continuous drainage of pus. Among them, 3 cases were stage Ⅰ renal nephrostomy, 8 cases were gravel, 9 cases were stage Ⅱ and 2 cases were stage Ⅲ. Results: The operation time of stage Ⅰ was 15-70min with an average of 47min. Bleeding 50 ~ 200ml, with an average of about 100ml, no blood transfusion, no serious urinary tract injury, complications surrounding organs and other complications. No postoperative bleeding, perinephric abscess, septic shock. Postoperative fever in 4 cases, the choice of sensitive antibiotics or broad-spectrum antibiotics to enhance anti-infective and supportive treatment symptoms disappear. 2 cases of residual stones, ESWL treatment. Stone clearance rate was 81.8% (9/11). Conclusion: The standard channel ultrasonic gravel combined with negative pressure to attract and staging surgery for multiple renal stones with purulent kidney can fully drain the pus, control the infection, quickly remove stones, and avoid serious complications, clinical safety and effectiveness.