输尿管结石梗阻致尿脓毒症急症减压方法的探讨  

Discussion on urgent decompression for urosepsis associated with ureteral obstruction caused by ureteral calculi

作　　者：解海杰[1] 史启铎[1] 

机构地区：[1]天津医科大学第二医院泌尿外科天津泌尿外科研究所,天津300211

出　　处：《临床泌尿外科杂志》2013年第10期775-777,共3页Journal of Clinical Urology

摘　　要：目的:本研究探讨输尿管结石梗阻致尿脓毒症的急症减压方法。方法:输尿管结石梗阻导致尿脓毒症患者106例,根据病情分期采取不同急症减压方法解除梗阻:①膀胱镜下逆行留置双J管引流。②经皮肾造瘘引流。③经尿道输尿管镜气压弹道碎石术后留置双J管引流。结果:所有患者均减压成功,其中105例患者术后情况有不同程度的改善,感染得到控制。一般脓毒症患者术后恢复时间(3.25±1.71)d,严重脓毒症患者术后恢复时间(6.38±1.94)d,脓毒性休克患者术后恢复时间(15.55±2.46)d(P<0.01);1例脓毒性休克伴有弥漫性血管内凝血患者死亡。结论:根据病情分期选择适当的急症减压方法及时解除梗阻对于控制输尿管结石梗阻致尿源性脓毒症至关重要。Objective： To investigate the urgent decompression of urosepsis associated with ureteral obstruction caused by ureteral calculi. Method： One hundred and six cases of urosepsis associated with ureteral obstruction caused by ureteral calculi underwent emergency drainage for decompression. According to the severity of the urosepsis there are three options of urgent decompression of obstructed collecting systems. The first way was to indwell double-J stent retrogradely with cystoseope. The second choice was to place a nephrostomy catheter percu- taneously. The third option was to indwell ureteral double J stent after transureteroscopic pneumatic lithotripsy. Result： All patients successfully underwent emergency drainage for decompression, in which 105 cases improved after urgent decompression. The recovery time after emergency drainage were as follows： general sepsis patients （3.25±1.71） d, severe sepsis patients （6.38±1.94） d, septic shock patients （1,5.55±2.46） d （P〈0.01）. One patient who suffered from septic shock combined with disseminated intravascular coagulation died. Conclusion： It is a crucial point for patients with urosepsis caused by acute obstructive ureteral calculi to choose an appropriate option of urgent decompression according to the clinical status of infection.

关 键 词：输尿管结石 尿路梗阻 感染 尿脓毒症 急症引流 

分 类 号：R693.4[医药卫生—泌尿科学]