输尿管镜钬激光碎石术对输尿管结石术患者发生感染的可行性及安全性研究  

Study on feasibility and safety of holmium laser lithotripsy under ureteroscope on ureteral calculi complicated with infections

作　　者：李辉[1] 王伟高[1] 谢波[2] 

机构地区：[1]湖州市第一人民医院泌尿外科,浙江湖州313000 [2]浙江省立同德医院泌尿外科,浙江杭州310012

出　　处：《中华医院感染学杂志》2015年第8期1857-1859,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生基金资助项目(2011KYA027)

摘　　要：目的探讨顺行与逆行输尿管镜下钬激光碎石术对输尿管结石发生感染的可行性及安全性,为临床诊断治疗提供参考。方法选取2012年11月-2014年1月118例输尿管结石发生感染患者为研究对象,根据手术方式不同分为顺行输尿管镜下钬激光碎石术(MPCNL)组59例和逆行输尿管镜下钬激光碎石术(URL)组59例;MPCNL组采用顺行输尿管镜下钬激光碎石术治疗,URL组采用逆行输尿管镜下钬激光碎石术治疗,对比分析两组患者临床疗效。结果共分离118株病原菌,其中革兰阴性菌85株占72.03%,主要包括肺炎克雷伯菌、铜绿假单胞菌及大肠埃希,革兰阳性菌33株占27.97%,主要包括金黄色葡萄球菌、粪肠球菌、凝固酶阴性葡萄球菌;MPCNL组手术时间(39.57±14.26)min、住院时间(5.26±1.84)d,URL组分别为(52.14±12.64)min、(7.24±1.97)d,两组比较差异有统计学意义(P<0.05)。结论顺行输尿管镜下钬激光碎石术对机体全身影响低于逆行输尿管镜下钬激光碎石术,且可缩短手术时间及住院时间,具有重要研究价值。OBJECTIVE To explore the feasibility and safety of anterograde and retrograde holmium laser lithotripsy under ureteroscope on ureteral calculi complicated with infections so as to provide guidance for the clinical diagnosis and treatment.METHODS A total of 118 patients with ureteral calculi who were treated from Nov 2012 to Jan2014were recruited as the study objects and divided into the anterograde holmium laser lithotripsy under ureteroscope（MPCNL）group with 59 cases and the retrograde holmium laser lithotripsy under ureteroscope（URL）group with 59 cases according to the mode of surgery.The MPCNL group was treated with the anterograde holmium laser lithotripsy under ureteroscope,while the URL group was treated with retrograde holmium laser lithotripsy under ureteroscope,and the clinical effect was observed and compared between the two groups.RESULTS Totally 118 strains of pathogens have been isolated,including 85（72.03%）strains of gram-negative bacteria and 33（27.97%）strains of gram-positive bacteria;the Klebsiella pneumoniae,Pseudomonas aeruginosa,and Escherichia coli were dominant among the gram-negative bacteria;the Staphylococcus aureus,Enterococcus faecalis,and coagulase-negative Staphylococcus were the predominant species of the gram-positive bacteria.The operation duration of the MPCNL group was（39.57±14.26）min,the URL group（52.14±12.64）min;the length of hospital stay of the MPCNL group was（5.26±1.84）days,the URL group（7.24±1.97）days,and there was statistically significant difference between the two groups（P〈0.05）.CONCLUSION The anterograde holmium laser lithotripsy under ureteroscope has less systemic effect than the retrograde holmium laser lithotripsy under ureteroscope,it can shorten the operation duration and the length of hospital stay,with great value to study.

关 键 词：输尿管镜下钬激光碎石术 顺行与逆行 输尿管结石 感染 

分 类 号：R619.3[医药卫生—外科学]