输尿管结石合并尿脓毒血症致血小板减少患者外科手术的有效性及安全性分析  

Efficacy and Safety of Surgery in Treatment of Patients with Thrombocytopenia Induced by Ureteral Calculi and Urine Sepsis

作　　者：李远伟[1] 吴万瑞[1] 卢强[1] 廖智[1] 李卓[1] 高智勇[1] 刘哲[1] 袁武雄[1] 段义星[1] 周强[1] 

机构地区：[1]湖南省人民医院(湖南师范大学第一附属医院)泌尿外科,湖南省长沙市410005

出　　处：《中国全科医学》2014年第15期1778-1780,共3页Chinese General Practice

基　　金：湖南省自然科学基金项目(12JJ5042);湖南省人民医院仁术科研发展基金项目(2011年)

摘　　要：背景输尿管结石合并尿脓毒血症所致的血小板减少患者,病情危重,需要急诊引流。如何选择手术方式,保证患者生命安全,对医生是一个很大的挑战。目的探讨对输尿管结石合并尿脓毒血症致血小板减少患者外科手术治疗的有效性和安全性。方法选取本院2011年1月—2013年5月收治的输尿管结石合并尿脓毒血症致血小板减少患者23例,均给予外科手术治疗。手术治疗流程：（1）局麻下急诊试行双J管内引流或输尿管导管引流;（2）如不成功者,对中下段结石行急诊输尿管镜下钬激光碎石术,中上段结石行输尿管切开取石手术;对于中重度积水合并脓肾患者行一期经皮肾造瘘术,二期处理输尿管结石;（3）对于严重肾功能不全患者,不能耐受外科手术者,先行急诊透析后再行外科干预;血小板过少有自发性出血倾向者则先输血小板等处理。结果 23例患者中,行一期输尿管开放切开取石术3例（13.0%）,试行留置双J管或输尿管导管20例（87.0%）,其中置管失败4例（20.0%）,改为一期输尿管镜下钬激光碎石术3例和一期肾造瘘术1例,间隔5-7 d后行二期经皮肾镜碎石术;置管成功16例（80.0%）,间隔7~30 d后行二期输尿管镜下钬激光碎石术13例、经皮肾镜碎石术2例、腹腔镜下输尿管切开取石术1例。血小板计数在术后1~7 d恢复至正常,术后3~7 d血尿消失,术后临床症状不同程度缓解,无麻醉相关并发症,无患者死亡。结论输尿管结石合并尿脓毒血症致血小板减少患者需要急诊处理,准确评估病情,完善术前准备后,微创手术和开放手术均是安全有效的。Background Patients with thrombocytopenia induced by ureteral calculi and urine sepsis are in a critical condition,these severe patients need emergency drainage.Choosing the proper surgical procedures,and ensuring patients safety,are great challenges to doctors.Objective To evaluate the efficacy and safety of surgical management in treatment of patients with thrombocytopenia induced by ureteral calculi and urine sepsis.Methods A total of 23 patients with thrombocytopenia induced by ureteral calculi and urine sepsis who were treated in our hospital from January 2011 to May 2013,were selected as study subjects,all of them received surgical treatment.The course of surgical treatment：emergency double J tube internal drainage or ureteral catheter drainage under local anesthesia;If step 1 was unsuccessful,holmium laser lithotripsy under ureteroscope was used to treat middle- lower ureter,ureterolithotomy was used to treat middle- upper ureter.Patients with moderate to severe hydrops and pyonephrosis received one- stage percutaneous nephrostomy first,then ureteral calculus was treated;Patients with severe renal dysfunction,and patients who can not tolerate surgery,emergency dialysis was used before performing surgery.Platelet transfusions were traditionally given to those patients with too few platelets.Results Among 23 cases,3（13.0%） cases received ureterolithotomy,among 20（87.0%） cases who received double J tube internal drainage or ureteral catheter,tube insertion failed in 4（20.0%） cases,among these 4 cases,3 cases received one- stage holmium laser lithotripsy under ureteroscope,1 case received one- stage percutaneous nephrostomy,they received two- stage percutaneous nephrolithotripsy after 5- 7 days;Catheterization was done successfully in 16（80.0%） cases,among these 16 cases,7- 30 days later,13 cases received two- stage holmium laser lithotripsy under ureteroscope,2 cases received percutaneous nephrolithotripsy,1 case received laparoscopic ureterolithotomy.Blood platelet count went back to normal

关 键 词：输尿管结石 脓毒症 血小板减少 引流术 外科手术 

分 类 号：R693.4[医药卫生—泌尿科学]