文档介绍：泌尿外科腔镜技术治疗结石性脓肾
作者:徐劲松, 李清,曹友汉,刘世敏
【摘要】目的:探讨运用腔内泌尿外科技术治疗结石性脓肾的安全性和有效性。方法:78例结石性脓肾患者中,4例行Ⅰ期脓肾切除术,53例行Ⅰ期内腔镜手术(21例行Ⅰ期经尿道输尿管镜取石术, 32例行Ⅰ期微创经皮肾镜取石术),21例行Ⅱ期手术,即Ⅰ期经皮肾微造瘘引流、Ⅱ期腔内技术取石术(18例)或肾切除术(3例)。碎石术采用气压弹道治疗19例,钬激光治疗52例。结果:71例内镜取石术中63例(%)结石被取净,8例行肾切除术,无术后大出血、感染性休克、脓肿播散等严重并发症;37例随访1~12个月,29例(%)肾功能得到不同程度恢复,8例(%)患肾萎缩(无功能)。结论:采用腔内泌尿外科技术(尤其是结合钬激光技术)治疗结石性脓肾安全、有效,保肾率高,可作为结石性脓肾的首选治疗方法;应根据具体情况选择Ⅰ期或Ⅱ期手术。
【关键词】结石;脓肾;内腔镜;气压弹道;钬激光
[ABSTRACT] Objective: To investigate the safety and efficacy of surgical endoscopic techniques in treating calculous pyonephrosis. Methods: 78 patients with calculous pyonephrosis were involved, of 4 patients with pyonephrosis were taken stageⅠ
nephrectomy, of 53 patients were underwent stageⅠendoscopic surgery (21 cases were gave calculus removed by transurethral ureteroscope, 32 cases were done percutaneous nephrolithotripsy), of 21 patients were stage Ⅱoperation including stageⅠpercutaneous renal microfistulation, stage Ⅱ stone extraction with endoscope in 18 or nephrectomy in 3 cases. 19 patients were treated by pneumatic ballistic lithotripsy, 52 cases by holmium laser therapy. Results: 63 of 71 patients treated by endoscopic stone extraction technique were satisfied with no remained stones, of 8 were nephrectomy. Postoperatively, there were no plications such as bleeding and septic shock and abscess scattering. All patients were followed up 1~