上尿路结石合并尿脓毒血症的治疗

目的探讨上尿路结石合并尿脓毒血症的治疗方案。方法回顾2014年7月~2018年5月在我院确诊收治的43例上尿路结石合并尿脓毒血症患者的临床资料,43例患者均行积极抗感染治疗,同时,一期行经输尿管镜下逆行插管术或经皮肾穿刺造瘘术,以解除梗阻,待患者感染控制后,二期行经输尿管镜或经皮肾镜碎石术。结果一期行经输尿管镜下逆行插管术29例,单侧结石23例,双侧结石6例,均成功置入导管。不宜行经输尿管镜下逆行插管术或逆行插管术失败者,在B超定位下行经皮肾穿刺造瘘术,共14例。待感染控制、病情稳定后出院,出院1个月后,再二期行腔内微创手术处理结石,碎石成功41例,碎石率95.35%(41/43),2例患者术后行体外冲击波碎石治疗,出院后3个月随访,42例患者结石排净,结石排净率为97.67%(42/43),肾功能及肾积水程度明显改善,43例患者在整个治疗过程中未出现严重并发症。结论经输尿管镜下逆行插管术或经皮肾穿刺造瘘术联合腔内微创手术是治疗上尿路结石合并尿脓毒血症的一种安全、有效的方法。

The treatment for upper urinary stones complicated with urosepsis

［Abstract］ Objective To investigate the treatment of upper urinary stones complicated with urosepsis. Methods We retrospectively analyzed the clinical data of 43 patients with upper urinary stones complicated with urosepsis in our hospital between July 2014 and May 2018. All 43 patients received active anti-infection treatment. The first stage interventions included retrograde ureteroscope intubation or percutaneous nephrostomy placement for removal of obstruction. After the infection was controlled， a second stage operation of ureteroscopic or percutaneous nephroscopic lithotripsy was performed. Results Among first stage retrograde ureteral stenting， there were 23 cases of unilateral stones and 6 cases of bilateral stones stenting succeed. B-ultrasound guided percutaneous nephrostomy was carried out in cases of unfit for retrograde ureteral stenting and failed stenting. After the infection was controlled and stable general situations were obtained， a second stage treatment with minimal invasive surgery was performed. The lithotripsy rate was 95.35% （41/43）. Two patients underwent extracorporeal shock wave lithotripsy after surgery. After a mean follow-up of 3 months， the stone clearance rate was 97.67% （42/43）， and the renal functions were preserved or improved in all the cases. No serious complications in all 43 patients. Conclusion Retrograde ureteroscope intubation or percutaneous nephrostomy combined with minimally invasive surgery is a safe and effective method for treating patients with upper urinary stones complicated with urosepsis， and worthy of being widely applied in clinic。