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目的探讨应用一步式经皮肾穿刺造瘘术(PCN)在结石梗阻性肾积脓中的应用价值。方法对36例上尿路结石梗阻性肾积脓患者在超声引导下采用一步式PCN直接穿刺引流。待感染控制、机体状况好转后二期手术,经建立的瘘道行肾镜超声碎石取石术10例,经尿道输尿管镜碎石取石术24例,肾切除2例。结果 36例患者均穿刺成功,及时解除梗阻。其中一次穿刺成功34例,二次穿刺成功2例。术后均尿液引流通畅,尿路感染得到控制。其中34例患侧肾功能恢复正常或改善,2例肾无功能。二期手术未发生感染加重、菌血症、败血症、休克等并发症。结论一步式PCN成功率高、创伤小、并发症少,能迅速解除梗阻,有利于控制感染、挽救肾功能,可为二期应用腔内技术碎石取石创造条件,并能提高手术的安全性,对结石梗阻性肾积脓的诊治具有重要的应用价值。
Objective To investigate the value of one-step percutaneous nephrostomy (PCN) in obstructive pyelolithiasis. Methods Thirty-six patients with upper ureteral calculi obstructive nephrolithiasis were treated with ultrasound-guided one-step PCN direct puncture and drainage. To be infection control, the body condition improved after two operations, the established fistula line nephrolithotomy lithotripsy in 10 cases, transurethral ureterolithotomy in 24 cases, 2 cases of nephrectomy. Results 36 patients were successful puncture, and promptly relieve the obstruction. One of the successful puncture 34 cases, 2 cases of successful puncture. Urine drainage were smooth after surgery, urinary tract infection was controlled. 34 cases of ipsilateral renal function returned to normal or improved, 2 cases of renal function. Secondary surgery did not occur aggravated infection, bacteremia, septicemia, shock and other complications. Conclusion One-step PCN has high success rate, less trauma and less complications, can quickly relieve the obstruction, is good for controlling infection and saving renal function, and can create the conditions for the second stage application of intraluminal lithotripsy and improve the safety of operation , The diagnosis and treatment of obstructive renal pythons has an important value.