上尿路结石合并感染的治疗策略  

The Strategy of Treatment for Upper Urinary Tract Stones with Infections

作　　者：尉春晓[1] 陈修德[1] 张安学[1] 张建军[1] 于江[1] 金讯波[1] 

机构地区：[1]山东大学附属省立医院泌尿微创中心,山东济南250014

出　　处：《泌尿外科杂志（电子版）》2011年第4期25-28,共4页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的总结上尿路结石合并感染的治疗经验。方法分析2011年8月至2011年10月收治的110例上尿路结石合并感染患者的临床资料,对治疗经验进行总结。所有患者均进行结石患者入院常规检查,包括尿常规、尿细菌培养+药敏试验、KUB平片和泌尿系CT检查等。对于发热、尿液中白细胞增高或尿细菌培养阳性的患者,给予经验性或依据药敏结果的抗生素治疗。对于合并肾积脓的患者一期行经皮肾穿刺造瘘引流或输尿管内双J管置入引流,待感染控制后再行针对结石的治疗。采用的结石治疗方法包括排石疗法、体外冲击波碎石术、输尿管镜碎石术、经皮肾镜碎石术和腹腔镜手术。所有手术患者均放置输尿管内双J管引流,施行经皮肾镜碎石术和腹腔镜手术的患者尚需留置肾造瘘管和腹腔引流管。术后继续应用抗生素治疗至患者体温、尿常规白细胞和细菌培养恢复正常。结果 11例患者行排石疗法、8例患者行体外冲击波碎石术联合排石疗法后结石排出,复查B超或KUB未见明显结石或石街形成。9例合并肾积脓的患者一期手术后引流尿液行细菌培养示阳性者7例。91例手术患者均顺利度过围手术期,术后无感染性休克发生。所有发热、尿中白细胞增高和细菌培养阳性患者在出院时均恢复正常。结论上尿路结石患者多合并感染,常规行尿常规和尿细菌培养检查并指导用药、术中应用抗生素并仔细操作、术后留置合适引流能有效控制感染,减少并发症。<Title>The Strategy of Treatment for Upper Urinary Tract Stones with Infections <Author>WEI Chun-xiao, CHEN Xiu-de, ZHANG An-xue, ZHANG Jian-jun, YU Jiang, JIN Xun-bo(Minimally Invasive Urologic Center, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250014, China) Objective To report our experience in the treatment of upper urinary tract stones with infection. Methods A retrospective analysis was made of 110 patients with upper urinary tract stones and urinary infection between August 2011 and October 2011. Routine tests were performed in all patients, including urine analysis, urine culture and the drug sensitivity and resistance of bacteria, KUB and CT. Antibiotics were used in patients who had fever and high level leucocyte,according to urine culture and the drug sensitivity and resistance of bacteria. Patients with pyonephrosis underwent percutaneous nephrostomy firstly,or retrograde insertion of double J stent,and then stones were managed after contronlling infection. Several methods were implied in the treatment of stones, including litlaagogue therapy, extracorporeal shock-wave lithotripsy (ESWL), ureteroscopic lithotripsy (URL), percutaneous nephroscopic lithotripsy (PCNL) and laparoscopic operation. The double J stent was inserted in all the patients while nephrostomy canal and peritoneal cavity drainage canal were placed in patients with PCNL and laparoscopic operation. Antibiotics were used postoperatively until the temperature, urine analysis and urine culture returned to normal. Results The stones were expelled in 11 patients with litlaagogue therapy and 8 patients with ESWL combined with litlaagogue therapy. No stones or stone street was observed by KUB or ultrasonography. Drainaged urine culture was positive in 7 of 9 patients with pyonephrosis after one-stage operation. All of the 91 patients remained safe after surgeries with no septic shock. Patients with infections recovered at discharge. Conclusions Infection is common in patients with upper urinary tract stones.

关 键 词：上尿路结石 感染 细菌培养 抗生素 

分 类 号：R691.4[医药卫生—泌尿科学]