CAJ | 학술논문

目的探讨上尿路结石合并脓肾的治疗方法及疗效.方法选择2004年5月至2010年2月在我科接受诊治的49例上尿路结石梗阻性脓肾患者,采用经尿道输尿管镜碎石取石术并置管内引流22例,经皮肾穿刺造瘘外引流术27例.结果采用微创内、外引流术中均未出现败血症、感染性休克症状.Ⅱ期行经皮肾镜取石术或开放肾盂、输尿管切开取石术,术中出现寒战、发热等菌血症状者3例(8.3%),3例肾切除术.33例随访3个月～5.5年,所有患肾功能均有不同程度的恢复,未发现患侧肾无功能而采取切肾者.结论早期诊断、及时引流、解除梗阻是上尿路结石合并脓肾保肾治疗的关键.输尿管镜碎石并留置双J导管及经皮肾穿刺造瘘引流是较好的解除梗阻的方法,安全、并发症较少且为Ⅱ期手术治疗创造良好的条件.
목적 탐토상뇨로결석합병농신적치료방법급료효.방법 선택2004년5월지2010년2월재아과접수진치적49례상뇨로결석경조성농신환자,채용경뇨도수뇨관경쇄석취석술병치관내인류22례,경피신천자조루외인류술27례.결과 채용미창내、외인류술중균미출현패혈증、감염성휴극증상.Ⅱ기행경피신경취석술혹개방신우、수뇨관절개취석술,술중출현한전、발열등균혈증상자3례(8.3%),3례신절제술.33례수방3개월～5.5년,소유환신공능균유불동정도적회복,미발현환측신무공능이채취절신자.결론 조기진단、급시인류、해제경조시상뇨로결석합병농신보신치료적관건.수뇨관경쇄석병류치쌍J도관급경피신천자조루인류시교호적해제경조적방법,안전、병발증교소차위Ⅱ기수술치료창조량호적조건.
Objective To improve the treatment of pyonephrosis with upper urinary tract calculi (UTC).Methods 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.Results 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 ephrectomy.Conclusion 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.