Urology and Lithotripsy Center, Peking University People's Hospital, 133 Fuchengmen inner Street, Beijing, 100034, People's Republic of China.
Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China.
BMC Surg. 2020 Dec 10;20(1):327. doi: 10.1186/s12893-020-00992-5.
Calculous pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost complete loss of renal function.
The clinical data of laparoscopic nephrolithotomy performed at Peking University People's Hospital from May 2017 to June 2020 were analyzed retrospectively. Eight patients (2 men; 6 women) aged 27 to 65 years (average age, 45.8 years) were included. Among them, 7 patients were treated with retroperitoneal approach and 1 patient by transperitoneal approach. All patients had received more than one endoscopic lithotripsy before nephrectomy. Renal dynamic imaging and computed tomography revealed the absence of function in pyonephrosis before nephrectomy. General clinical data and perioperative data were recorded. All nephrectomies were performed by the same physician.
Laparoscopic surgery was successfully performed in 7 patients; however, 1 patient underwent open surgery because of bleeding. The operation time, average operation time, and blood loss were 1.5-4.5 h, 3.4 h, and 100-1000 ml (average, 300 ml), respectively. The postoperative pathology showed inflammatory renal disease in 6 patients, xanthogranulomatous pyelonephritis in 1 patient, and high-grade urothelial cancer in 1 patient. The average postoperative hospital stay was 5.3 days. One patient had a Clavien-Dindo Grade IIIb complication (severe hematuria), which required laparotomy, and was found that there was bleeding of ureteral stump. None of the patients experienced poor healing of endoscopic wounds.
For patients with complicated calculous pyonephrosis, renal inflammation could not be effectively controlled, and renal function was seriously damaged. Thus, kidneys should be immediately resected. With laparoscopy, patients may recover quickly, but surgeons require enough experience when performing laparoscopy to achieve safety.
结石性脓肾是一种疾病，其特征为感染性肾盂积水合并化脓性肾实质破坏，导致肾功能完全或几乎完全丧失。
回顾性分析 2017 年 5 月至 2020 年 6 月北京大学人民医院行腹腔镜肾切除术的临床资料。共纳入 8 例患者（男 2 例，女 6 例），年龄 27～65 岁，平均 45.8 岁。其中，7 例采用后腹腔镜入路，1 例采用经腹腔入路。所有患者均在肾切除术前接受了多次内镜碎石术。术前肾动态成像和 CT 显示脓肾无功能。记录患者的一般临床资料和围手术期资料。所有肾切除术均由同一位医师完成。
7 例患者成功实施了腹腔镜手术，1 例患者因出血转为开放手术。手术时间为 1.5～4.5 h，平均 3.4 h，术中出血量为 100～1000 ml，平均 300 ml。术后病理示 6 例为炎症性肾病，1 例为黄色肉芽肿性肾盂肾炎，1 例为高级别尿路上皮癌。术后平均住院时间为 5.3 d。1 例患者出现 Clavien-Dindo Ⅲ b 级并发症（严重血尿），需要剖腹探查，发现输尿管残端出血。所有患者内镜伤口愈合不良。
对于复杂的结石性脓肾患者，肾脏炎症无法有效控制，肾功能严重受损，应立即切除肾脏。腹腔镜手术可使患者快速康复，但术者需要有足够的腹腔镜手术经验以保证手术安全。
