Tu Min-qi, Shi Guo-wei, He Jia-yang
Department of Urology, Shanghai 5th People's Hospital, Fudan University, Shanghai 200240, China.
Zhonghua Yi Xue Za Zhi. 2011 Apr 26;91(16):1115-7.
To improve the treatment of pyonephrosis with upper urinary tract calculi (UTC).
A total of 49 UTC patients with pyonephrosis were selected at our hospital during May 2004 to February 2010. Among them, 22 cases were treated with transurethral ureteroscope lithotripsy followed by tube internal drainage while another 27 cases underwent percutaneous nephrolithotomy.
No such complications as septicemia and septic shock occurred during the first stage of external and internal drainage. The bacteremic symptoms of chill or fever occurred in 3 cases during the second stage of percutaneous nephrolithotomy and pyelolithotomy/ureterolithotomy (11.1%). There were 3 cases of nephrectomy. A follow-up period of 3 months to 5.5 years showed that all 33 cases had a varying degree of recovered renal functions. And there was no nephrectomy.
The keys to a successful surgical treatment of pyonephrosis with upper urinary tract calculi are early diagnosis, timely drainage and relief of obstruction. Ureteroscopic lithotripsy, double-J placement and percutaneous nephrostomy drainage are excellent for relieving obstruction. As a safe procedure with minor complications, it creates proper conditions for a second stage operation.
提高上尿路结石伴肾积脓的治疗效果。
选取2004年5月至2010年2月我院收治的49例上尿路结石伴肾积脓患者。其中，22例行经尿道输尿管镜碎石术并置管内引流，27例行经皮肾镜取石术。
在一期内外引流阶段未发生败血症、感染性休克等并发症。在经皮肾镜取石术及肾盂/输尿管切开取石术的二期手术中有3例（11.1%）出现寒战或发热的菌血症症状。有3例行肾切除术。随访3个月至5.5年，33例肾功能均有不同程度恢复，且无肾切除病例。
上尿路结石伴肾积脓手术治疗成功的关键在于早期诊断、及时引流及解除梗阻。输尿管镜碎石、双J管置入及经皮肾造瘘引流解除梗阻效果良好。作为一种并发症少的安全手术，为二期手术创造了合适条件。
