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目的:提高运用微通道经皮肾镜气压弹道碎石术术治疗感染性鹿角形肾结石的能力。方法:2009年1月~2014年6月,共有73例(77侧)感染性鹿角形肾结石患者接受微通道经皮肾镜气压弹道碎石术术治疗。回顾性分析此73例患者的临床资料,统计手术时间、术后血红蛋白(Hb)下降值、术后输血率、一期结石清除率、术后发热发生率以及并发症发生情况。结果:73例(77侧)患者均成功建立一期经皮肾通道并完成一期取石手术。手术时间为51.7~212.0 min,平均(102.3±42.2)min。Hb下降值为9~47g/L,平均(17.3±5.4)g/L。7.8%(6/77)术后接受了输血。一期结石清除率为74.0%(57/77),结合体外冲击波碎石(ESWL)治疗一期结石清除率为81.8%(63/77)。术后发热发生率为10.4%(8/77)。1例患者因为输血治疗无效行超选择性肾动脉栓塞止血,1例患者发生尿脓毒症休克,无周围器官损伤发生,无死亡病例。结论:在充分掌握手术技巧、完善术前风险控制和术后管理的前提下,微通道经皮肾镜气压弹道碎石术术治疗感染性鹿角形肾结石不失为一种安全有效的方法。
Objective: To improve the ability of using microchannel percutaneous nephroscopic pneumatic lithotripsy in the treatment of infectious antler kidney stones. METHODS: From January 2009 to June 2014, a total of 73 patients (77 sides) of infected antler kidney stones were treated with micro-channel percutaneous nephrolithotomy. The clinical data of 73 patients were retrospectively analyzed. The operation time, postoperative hemoglobin (Hb) decline, postoperative blood transfusion rate, primary stone removal rate, postoperative fever incidence and complications were analyzed. Results: A total of 73 patients (77 patients) were successfully established a percutaneous renal access and completed a stage stone surgery. The operation time was 51.7 ~ 212.0 min, with an average of (102.3 ± 42.2) min. Hb decreased 9 ~ 47g / L, with an average (17.3 ± 5.4) g / L. 7.8% (6/77) received blood transfusions after surgery. The first stage stone clearance rate was 74.0% (57/77), combined with extracorporeal shock wave lithotripsy (ESWL) treatment of stone clearance rate was 81.8% (63/77). The incidence of postoperative fever was 10.4% (8/77). One patient died of transselective renal artery embolism because of ineffective blood transfusions. One patient developed urinary sepsis without peripheral organ injury and no deaths occurred. Conclusions: Micro channel percutaneous nephrolithotrude pneumatic lithotripsy is a safe and effective method for the treatment of infectious antler kidney under the premise of fully mastered surgical techniques and perfected preoperative risk control and postoperative management.