经皮肾镜联合碎石清石系统治疗肾输尿管结石合并脓肾的体会
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摘要
目的探讨经皮肾镜联合碎石清石系统治疗肾输尿管结石并脓肾的临床疗效,并总结治疗经验。方法选取2012年1月~2014年1月笔者医院收治的31例肾输尿管结石合并脓肾患者,所有患者均经一期标准通道经皮肾镜碎石取石术(percutaneous nephrostolithotomy,PCNL)治疗,并对其临床资料进行回顾性分析。结果术后血尿1例(3.23%),术后肾周围性血肿2例(6.45%),术后发热5例(16.13%),感染性休克2例(6.45%),并发症发生率为32.26%;手术相关血红蛋白的下降幅度为8.57±2.63g/L,术后白细胞计数为(9.82±1.37)×109/L,术中均未出现严重出血或感染,手术均顺利完成。结论在使用一期标准通道PCNL治疗肾输尿管结石并脓肾时,需联合使用EMS碎石清石系统,并注意对常见并发症的预防,以确保手术疗效良好。
Objective To evaluate the percutaneous endoscopic lithotripsy kidney stone clearance system for the treatment of renal and ureteral calculi renal abscess clinical efficacy and summarize treatment experience. Methods Selected 31 cases of ureteral stone and pus kidney patients who were treated in our hospital between January 2012 to January 2014,allpatients,all patients were confirmed by a standard channel percutaneous nephrolithotomy lithotripsy( Percutaneous Nephrostolithotomy,PCNL) treatment,and retrospectively analyzed the clinical data. Results One case is postoperativehemauria( 3. 23%),2 cases is postoperative renal peripheral hematoma( 6. 45%),5 cases postoperative( 16. 13%),2 cases septic shock( 6. 45%),the total complication rate is 32. 26%; surgery related to hemoglobin decrease of 8. 57 ± 2. 63 g / L,postoperative leukocyte count( 9. 82 ± 1. 37) × 109/ L,no serious intraoperative bleeding or infection,surgery was successfully completed. Conclusion When using a channel of standard PCNL treatment of renal and ureteral calculi renal abscess,require the joint use EMS gravel stone clearance system,and pay attention to the prevention of common complications,to ensure a good surgery.
Objective To evaluate the percutaneous endoscopic lithotripsy kidney stone clearance system for the treatment of renal and ureteral calculi renal abscess clinical efficacy and summarize treatment experience. Methods Selected 31 cases of ureteral stone and pus kidney patients who were treated in our hospital between January 2012 to January 2014,allpatients,all patients were confirmed by a standard channel percutaneous nephrolithotomy lithotripsy( Percutaneous Nephrostolithotomy,PCNL) treatment,and retrospectively analyzed the clinical data. Results One case is postoperativehemauria( 3. 23%),2 cases is postoperative renal peripheral hematoma( 6. 45%),5 cases postoperative( 16. 13%),2 cases septic shock( 6. 45%),the total complication rate is 32. 26%; surgery related to hemoglobin decrease of 8. 57 ± 2. 63 g / L,postoperative leukocyte count( 9. 82 ± 1. 37) × 109/ L,no serious intraoperative bleeding or infection,surgery was successfully completed. Conclusion When using a channel of standard PCNL treatment of renal and ureteral calculi renal abscess,require the joint use EMS gravel stone clearance system,and pay attention to the prevention of common complications,to ensure a good surgery.
引文
1张跃曦,田凯,王宜林,等.标准经皮肾镜联合EMS四代碎石清石系统治疗结石性脓肾的疗效分析[J].中国实用医药,2013,15(12):18-19
2 黄勇平,黄群,梁庆祖,等.B超引导下经皮肾镜联合EMS碎石清石系统治疗肾铸型结石[J].右江民族医学院学报,2013,4(7):479-480
3 杨文增,崔振宇,马涛,等.经皮肾镜Cyberwand双导管超声碎石清石系统治疗肾铸型结石体会[J].中国全科医学,2011,14(13):1601-1602
4 周明,江咏,李宏,等.新型经皮肾镜和输尿管镜联合弹道超声碎石、清石系统治疗肾结石[J].中国内镜杂志,2008,8(11):858-859,863
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7 史红雷,郭宏赛,李笑弓,等.肾结石患者行m PCNL中肾孟内压的测定及其临床意义[J].江苏医药,2007,33(6):612-613
8 肖仁举,陈伟,王时龙.经皮肾镜超声气压弹道碎石清石术治疗肾结石及输尿管上段结石(附217例报告)[J].中国医疗前沿,2009,2(4):20-21,73
9 曾祥勇,潘辅全,段珊,等.经皮肾镜联合超声碎石清石系统治疗胆管结石的临床应用研究[J].中国内镜杂志,2012,3(5):259-261
10 Tunc E,Yakup B,Ender O.Risk factors for systemic inflammatory response syndrome following percutaneous nephrolithotomy.Urolithiasis,2013,41:395-401
2 黄勇平,黄群,梁庆祖,等.B超引导下经皮肾镜联合EMS碎石清石系统治疗肾铸型结石[J].右江民族医学院学报,2013,4(7):479-480
3 杨文增,崔振宇,马涛,等.经皮肾镜Cyberwand双导管超声碎石清石系统治疗肾铸型结石体会[J].中国全科医学,2011,14(13):1601-1602
4 周明,江咏,李宏,等.新型经皮肾镜和输尿管镜联合弹道超声碎石、清石系统治疗肾结石[J].中国内镜杂志,2008,8(11):858-859,863
5 RabiiR,Joual A,Rais H,et al.Pyonephrosis:diagnosis and treatment:Report of 14 cases[J].Ann Urol,2000,34:161-164
6 Troxel SA,Low RK.Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever[J].J Urol,2002,168:1348-1351
7 史红雷,郭宏赛,李笑弓,等.肾结石患者行m PCNL中肾孟内压的测定及其临床意义[J].江苏医药,2007,33(6):612-613
8 肖仁举,陈伟,王时龙.经皮肾镜超声气压弹道碎石清石术治疗肾结石及输尿管上段结石(附217例报告)[J].中国医疗前沿,2009,2(4):20-21,73
9 曾祥勇,潘辅全,段珊,等.经皮肾镜联合超声碎石清石系统治疗胆管结石的临床应用研究[J].中国内镜杂志,2012,3(5):259-261
10 Tunc E,Yakup B,Ender O.Risk factors for systemic inflammatory response syndrome following percutaneous nephrolithotomy.Urolithiasis,2013,41:395-401