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目的评价标准经皮肾镜联合EMS四代碎石清石系统治疗结石性脓肾的安全性与疗效。方法结石性脓肾患者59例,其中21例Ⅰ期建立24F标准经皮肾通道,在保持低压的状态下行EMS四代超声联合气压弹道碎石、清石治疗;38例先行输尿管镜下留置DJ或经皮肾造瘘引流,再行Ⅱ期标准通道经皮肾镜取石术。结果所有病例均顺利完成手术,未出现大出血、肾周脓肿、脓毒血症及邻近脏器损伤等严重并发症。11例术后出现寒战、高热(>39℃),8例体温在38℃～39℃,其余病例术后体温<38.0℃。术后复查51例结石取净,8例结石残留,结石清除率为86.44%。术后病例随访3～12个月,肾功能恢复或部分恢复54例,肾萎缩5例。结论标准经皮肾镜联合EMS四代碎石清石系统治疗结石性脓肾安全、有效,应根据具体情况选择Ⅰ期或Ⅱ期手术。
Objective To evaluate the safety and efficacy of standard percutaneous nephrolithotomy combined with the fourth generation of gravel clear stone system in treating calculous pyogenic kidney. Methods 59 patients with calculous pyogenic kidney, of which 21 cases of stage I established 24F standard percutaneous renal access, under the condition of maintaining low pressure EMS four generations of ultrasound combined with pneumatic lithotripsy, clear stone treatment; 38 cases underwent first ureteroscopic indwelling DJ Or percutaneous nephrostomy drainage, and then the standard phase II percutaneous nephrolithotomy. Results All cases were successfully completed surgery, no major bleeding, perinephric abscess, sepsis and other serious complications of organ damage. Chills occurred in 11 cases, high fever (> 39 ℃), 8 cases of body temperature at 38 ℃ ~ 39 ℃, the remaining cases postoperative body temperature <38.0 ℃. Postoperative review of 51 cases of stone removed net, 8 cases of residual stones, stone clearance rate was 86.44%. Postoperative follow-up of 3 to 12 months, 54 cases of renal function recovery or partial recovery, 5 cases of renal atrophy. Conclusion Standard percutaneous nephrolithotomy with EMS four gravel stone system for the treatment of calculous pyogenic kidney safe and effective, according to the specific circumstances should choose Ⅰ or Ⅱ surgery.