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目的:评价经皮肾镜钬激光碎石术分期治疗结石性脓肾的安全性和治疗效果。方法:回顾性分析2009年6月~2013年9月收住的65例结石性脓肾患者临床资料:分别在B超引导下完成经皮肾镜钬激光碎石术,其中29例为Ⅰ期经皮肾镜钬激光碎石术(Ⅰ期组),36例为Ⅰ期穿刺引流后行Ⅱ期经皮肾镜钬激光碎石术(Ⅱ期组)。结果:两组均顺利完成手术。Ⅰ期组术后发热9例,高热4例,菌血症1例,肾周感染2例;Ⅰ期结石清除率为75.8%,结石残余7例(5例<1cm);造瘘管留置时间为(5.69±1.51)d,术后住院时间分别为(7.58±1.97)d,总住院时间为(14.46±4.47)d,总住院平均费用为(20 134±3 930)元。Ⅱ期组术后发热6例,高热2例,感染性休克1例;结石清除率为88.9%,结石残余4例(均<1cm);总住院时间平均为(19.53±5.65)d,造瘘管留置时间为(11.17±1.63)d,术后住院时间分别为(6.39±2.54)d,总住院平均费用为(28 261±3 191)元。比较造瘘管留置时间、总住院时间、住院费用等,两组差异有统计学意义(P<0.05)。均未出现肾切除、大出血、腹腔脏器损伤等严重并发症。结论:Ⅰ期经皮肾镜钬激光碎石术可有效减少患者术后留置造瘘管时间和住院时间,降低住院费用,通过有效的术前准备,注意术中操作细节,对选择性结石性脓肾患者是一种安全有效的治疗方法。
Objective: To evaluate the safety and therapeutic effect of percutaneous nephroscope holmium laser lithotripsy in the treatment of calculous pyogenic kidney. Methods: The clinical data of 65 patients with calculous pus received from June 2009 to September 2013 were retrospectively analyzed. Percutaneous nephrolithotomy with holmium laser lithotripsy was performed under B-mode ultrasound respectively. Among them, 29 patients were stage Ⅰ Percutaneous nephroscope holmium laser lithotripsy (stage Ⅰ group), 36 cases were stage Ⅰ percutaneous nephrolithotomy with holmium laser lithotripsy (stage Ⅱ). Results: Both groups successfully completed the operation. In group Ⅰ, 9 cases were fever, 4 cases were fever, 1 case was bacteremia and 2 cases were renal peritoneal infection. The rate of stone removal was 75.8% in stage Ⅰ, 7 cases were residual stones (5 cases <1 cm) (5.69 ± 1.51) d respectively. The length of postoperative hospital stay was (7.58 ± 1.97) d, the total length of hospital stay was (14.46 ± 4.47) days and the average hospitalization cost was (20 134 ± 3930) yuan. In group Ⅱ, postoperative fever was found in 6 cases, fever in 2 cases, and septic shock in 1 case. The rate of stone removal was 88.9% in all 4 cases (all <1 cm), and the average length of hospital stay was (19.53 ± 5.65) days. The stay time was (11.17 ± 1.63) days, the postoperative hospital stay was (6.39 ± 2.54) days, and the average hospitalization cost was (28 261 ± 3 191) yuan. Compared fistula indwelling time, total length of hospital stay, hospitalization costs, the difference between the two groups was statistically significant (P <0.05). Nephrectomy, hemorrhage, abdominal organ injury and other serious complications did not occur. Conclusions: Stage I percutaneous nephrolithotomy with holmium laser lithotripsy can effectively reduce the postoperative fistula catheterization time and hospitalization time, reduce hospitalization costs, through effective preoperative preparation, pay attention to the operation details, selective stone pus Kidney patients is a safe and effective treatment.