输尿管软镜治疗肾结石合并复杂尿路感染的疗效分析  

Clinical efficacy of flexible ureteroscopic lithotripsy in the treatment of renal stones complicated with urinary tract infection

作　　者：徐明曦[1] 达骏[1] 张明[1] 董国勤[1] 卢慕峻[1] 姚海军[1] 张克[1] 王忠[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院泌尿外科,上海200011

出　　处：《现代泌尿外科杂志》2015年第5期314-317,共4页Journal of Modern Urology

摘　　要：目的：评价输尿管软镜碎石取石术治疗肾结石伴难治性尿路感染的疗效和安全性。方法回顾分析2011年10月至2014年6月15例感染性肾结石应用输尿管软镜下钬激光碎石取石治疗的临床资料，与同期行输尿管软镜手术且无明显尿路感染患者进行对照。感染组15例患者术前均有尿路感染及发热症状，术前根据尿培养选用敏感抗生素治疗2周，尿中白细胞仍维持在100个／μL以上。手术使用Storz Flex‐X2 F7．5输尿管软镜进行碎石取石术，钬激光功率设置为0．8～1．0 J ／5～10 Hz ，术中留置F6双J管。术后观察体温变化、血常规及KUB。术后2周复查尿常规及尿路CT 平扫，评估尿路感染控制情况及排石效果。术后2～4周拔除双J管。结果所有患者均一次碎石成功。术中发现感染组15例患者肾盂内尿液浑浊、伴有絮状物，其中有2例结石被脓苔样组织包裹。术中用钬激光碎石，用套石篮取出碎石，取净脓苔样组织，平均手术时间（30±21）（15～50） min ，术后结石清除率为93．3％（14／15）；有2例（13．3％）出现术后发热，均在术后6 h内发生，最高体温在39℃以下，抗炎对症治疗后好转。结论敏感抗生素保护下行输尿管软镜碎石取石术是治疗感染性肾结石的安全有效的方法，其结石清除率高、并发症低，但术中需低压冲洗，且术后仍有出现发热的风险，需要密切关注。ABSTRACT：Objective To study the efficacy and safety of flexible ureteroscopic lithotripsy for renal stones complicated with recurrent urinary tract infection （UTI） .Methods Clinical data of 15 patients with renal stones and recurrent UTI （UTI group） were retrospectively reviewed .The patients were treated with flexible ureteroscopic lithotripsy during Oct .2011 to June 2014 .A group of 15 patients with renal stones but without any sign of UTI were included as controls .All patients in the UTI group presented urinary tract stimulus symptoms and fever .Antibiotics were given according to mid‐stream urine culture for two weeks .But routine urine test still showed white blood cell （WBC） 〉100/μL .Storz Flex‐X2 F7 .5 ureteroscope was stand‐ard equipment for the operation .Holium laser was set as 0 .8~1 .0 J /5~10 Hz .A F6 double J stent was inserted after the op‐eration .Vital signs ,routine blood test and KUB were observed as well .Two weeks after operation ,a routine urine test and non‐contrast CT scan were performed to evaluate UTI and stone free rate （SFR） .The double J stent was removed 2‐4 weeks after the operation .Results All operations were done in one‐stage .In the UTI group ,all cases had urinary cloudiness and two of them had pus covered the stones .All stones and pus were cleared in the surgery .The average operation time was （30 ± 21）min （15~50 min） .The stone free rate was 93 .3% （14/15） .Fever was observed in 2 （13 .3% ） cases within 6 hours after operation ,and the highest temperature was 39 ℃ .All patients were cured with antibiotics .Conclusions It＇s safe to perform flexible ureteroscopic lithotripsy on renal stone patients with recurrent UTI under the protection of sensitive antibiotics .The SFR and post‐operative complications were acceptable .Low‐pressure irrigation and careful post‐operative observation are of great importance for these patients .

关 键 词：输尿管软镜 尿路感染 肾结石 微创手术 

分 类 号：R691.4[医药卫生—泌尿科学]