不同引流术急诊处理输尿管结石梗阻合并尿脓毒血症的比较

目的比较2种不同引流术急诊处理输尿管结石梗阻合并脓毒血症的有效性及安全性。方法 2003年3月～2011年3月52例输尿管结石梗阻合并尿脓毒血症,27例采用输尿管镜直视下逆行置入双J管引流术(输尿管镜组),25例采用B超引导下经皮肾穿刺造瘘术治疗(经皮肾组)。结果输尿管镜组由6名不同级别术者完成,经皮肾组由2名高级别术者完成。输尿管镜组置管引流成功率(100%)明显高于经皮肾组(21/25,84.0%)(Fisher’s检验,P=0.047);2组术后尿脓毒血症控制时间无统计学差异[(6.5±1.2)d vs.(6.4±1.2)d,t=0.300,P=0.765];2组无输尿管穿孔、大出血及死亡等严重并发症。结论输尿管镜直视下逆行置入双J管引流术和经皮肾穿刺造瘘术均为急诊处理输尿管结石梗阻合并尿脓毒血症安全有效的方法;输尿管镜直视下逆行置入双J管引流术置管成功率更高;对于超声技术不熟练的术者和患肾轻度积水的患者,推荐首选输尿管镜手术。

Comparison of Two Drainage Approaches for Emergency Treatment of Ureteral Calculus Obstruction Complicated with Urinary Sepsis

Objective To compare the safety and efficacy of drainage via two different approaches for emergency treatment of ureteral calculus obstruction complicated with urinary sepsis.Methods From March 2003 to March 2011,52 patients with ureteral calculus obstruction complicated with urinary sepsis,were admitted to our hospital.Among the patients,27 patients underwent the drainage by inserting a double J tube under a retrograde ureteroscope(ureteroscopy group),the other 25 patients received percutaneous nephrostomy(percutaneous group).Results In the ureteroscopy group,the procedure was completed by six surgeons at different levels,whereas,in the percutaneous group,all the procedure was carried out by two senior doctors.The success rate of drainage in the ureteroscopy group was significantly higher than that in the percutaneous group [100% vs.84.0%(21/25),Fisher’s test: P=0.047].No significant difference was found in the time of controlling sepsis after the operation [(6.5±1.2) d vs.(6.4±1.2) d,t=0.300,P=0.765].Neither the group had ureteral perforation,massive bleeding or death.Conclusions Both percutaneous nephrostomy and double-J tube insertion by retrograde ureteroscopy are effective emergency treatments for patients with ureteral calculus obstruction complicated with urinary sepsis.However,we recommend the latter as the first choice,especially for unskilled surgeons and patients with mild hydronephrosis,as its success rate is higher.