输尿管结石合并糖尿病引发感染性休克16例临床分析  

Treatment of Infectious Shock Induced by Ureteral Calculi Complicated with Diabetes:Report of 16 Cases

作　　者：孙道冬[1] 孙丹宁[1] 高瑾[1] 王勤[1] 李靖[1] 颜加强[1] 康元上[1] 

机构地区：[1]解放军324医院泌尿外科,重庆400020

出　　处：《中国微创外科杂志》2010年第8期719-721,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨输尿管结石合并糖尿病引起感染性休克的治疗方法。方法回顾性分析2005年1月～2009年1月16例输尿管结石合并糖尿病致感染性休克患者的资料,经抗感染、抗休克等治疗1～2天,休克基本纠正(无需升压药维持,收缩压>90mmHg),空腹血糖<11mmol/L后,行输尿管镜治疗,配合钬激光、气压弹道碎石取石,并留置双J管引流。结果 16例治疗均获成功,14例一期碎石并取净结石,2例二期体外碎石,无手术并发症。术后当日体温、生命体征均恢复正常;术后5～7天白细胞恢复正常;术后1～4周B超肾积水有不同程度的缓解(无积水5例,轻度积水7例,中度积水3例,重度积水1例),输尿管扩张5～10mm,平均8.2mm;6例伴发肾功能不全者,血肌酐5例术后1周内恢复正常,1例术后4周恢复正常。16例随访2～4周,未见感染、结石残留。结论对糖尿病合并输尿管结石引发感染性休克的患者,应在积极抗感染、抗休克后,及早采取输尿管镜手术治疗。Objective To summarize our experience in the treatment infectious shock induced by calculus of the ureter in patients with diabetes.Methods From January 2005 to January 2009,totally 16 patients with ureteral calculi complicated with diabetes were treated admitted to our hospital because of infectious shock.Anti-infection and countershock therapies were carried out immediately on admission.And then,when the shock was corrected（systolic pressure 90 mm Hg without medication）,and fasting plasma glucose recovered to 11 mmol/L,we performed ureteroscopy combined with Holmium laser or pneumatic lithotripsy on the patients.Double-J catheters were indwelled after the operation.Results The surgery was completed successfully in all of the cases without leading to surgical complications.Among the 16 cases,the calculi were removed completely in the first operation in 14 patients;the other two patients received a second operation by ESWL.All the patients showed normal body temperature and other vital signs after the ureteroscopy.In 5 to 7 days after the surgery,their WBC count recovered to a normal range;and in 1 to 4 weeks,B-ultrasonography showed that hydronephrosis was relieved in all of the patients in different extents（5 patients had no hydronephrosis,7 had mild hydronephrosis,3 had mediate and 1 had severe hydronephrosis）,the ureter of the patients was dilated by 5 to 10 mm（mean,8.2 mm）.Meanwhile,laboratory examinations showed that,in the six patients with insufficient renal functions,the level of blood creatinine recovered to a normal range in one week postoperatively in 5 cases,the other one resumed normal level of serum creatinine in 4 weeks.The 16 patients were followed up for 2 to 4 weeks,during which no patient showed infections or residual calculi.Conclusion Ureterascopy should be employed opportunely after the anti-infection and countershock therapies for patients with infectious shock that is induced by ureteral calculi complicated with diabetes.

关 键 词：输尿管镜 感染性休克 输尿管结石 糖尿病 

分 类 号：R693.4[医药卫生—泌尿科学]