输尿管结石合并感染一期手术碎石的安全性及疗效

目的 探讨输尿管结石合并感染一期手术碎石的安全性及疗效.方法 回顾性分析2012年6月至2016年3月采用一期手术碎石处理的输尿管结石合并感染患者152例,男89例,女63例;年龄16～83岁,平均55岁;体温(耳朵)正常112例,38～39℃37例,大于39℃3例;术前常规予以敏感抗生素或广谱抗生素治疗,均采用经尿道输尿管硬镜钬激光碎石及输尿管支架管引流,术中优先排脓,再行碎石,冲洗液低压低流及定时肾盂内减压放流处理.结果 146例结石1次击碎完全,6例结石碎块较大上滑入肾盂,手术均成功解除尿路梗阻;有3例术中输尿管穿孔;术前体温小于39℃患者术中、术后无严重并发症发生,体温大于39℃的3例患者有2例出现休克情况,经抗感染及抗休克治疗,2～3d恢复正常.结论 在严格控制手术指针及手术操作流程下,输尿管结石合并感染的患者可以采用一期碎石处理,优点为时间短、费用低、损伤小、患者接受度高,满意度高,风险并没有明显增加.

Safety and curative effect of one stage surgical treatment of ureteral stone complicated with infection

Objectives To investigate the safety and efficacy of one stage surgical treatment of ureteral calculi complicated with infection.Methods From June 2012 to March 2016,152 patients with ureteral stone complicated with infection were analyzed retrospectively.The study included 89 males and 63 females.Ranging in age from 16 to 83 years old,average 55 years old,the 112 cases of temperature (ears) were normal,the temperature were 38 ～ 39℃ in 37 cases,and the temperature was greater than 39℃ in 3 cases.All patient were given sensitive antibiotics or broad-spectrum antibiotics before surgery.Using the ureter rigid ureteroscope holmium laser lithotripsy of ureteral stent tube drainage,were given priority for drainage of pus,and gravel,rinse liquid of low pressure and low flow and timing of renal pelvic pressure releasing process.Results 146 cases were treated once successfully,6 cases of stone had large fragments to slide into the renal pelvis.All the operations were successful in relieving urinary tract obstruction,3 cases of ureteral perforation occurred.There was no serious complications in patients (preoperative temperature was less than 39℃).Temperature was greater than 39℃ in three patients,there was shock in two cases and recovery 2 ～ 3 d.Conclusions The one stage surgical treatment of ureteral calculi complicated with infection has the advantages of short time,low cost,small injury,high degree of acceptance,high degree of satisfaction,low risk.