内、外引流方式在输尿管结石合并尿脓毒血症中应用的临床对照研究  

Clinical study on internal or external diversion for the treatment of ureteral calculus complicated with urosepsis

作　　者：李法江[1] 黄红星[1] 郑轶群[1] 黄海[2] 胡明 黎卫[1] 石映江[1] 

机构地区：[1]中山市人民医院泌尿外科,广东中山528403 [2]中山大学孙逸仙纪念医院泌尿外科,广州510120 [3]南海区人民医院泌尿外科,广东佛山528200

出　　处：《岭南现代临床外科》2015年第5期617-620,共4页Lingnan Modern Clinics in Surgery

摘　　要：目的 探讨对输尿管结石合并尿脓毒血症患者分别行内、外引流的治疗效果。方法我院2011年1月-2013年12月收治输尿管结石合并尿脓毒血症患者63例,随机分内引流组（31例）和外引流组（32例）,内引流组患者行膀胱镜或输尿管镜下双J管置入术,外引流组患者在B超引导下行经皮肾穿刺造瘘术,记录两组患者引流成功率,计算从引流成功至尿脓毒血症得到控制所需时间,记录输尿管镜碎石术后尿脓毒血症复发例数、感染性休克发生例数。结果 内、外引流组引流成功率分别为96.8%和90.6%,差异无统计学意义（P=0.3170）。两组患者尿脓毒血症所需控制时间分别为4.6±1.9 d和3.5±1.7 d,差异有统计学意义（P=0.0184）。内引流组输尿管镜碎石术后6例再发尿脓毒血症,而外引流组无1例再发,差异有统计学意义（P=0.0287）。内引流组再发脓毒血症患者中有1例出现感染性休克。结论 输尿管结石合并感染患者,内、外引流方式成功率均较高,但外引流控制感染时间短、输尿管镜碎石术后尿脓毒血症再发率低。Objective To investigate the therapeutic effect of by ureteral stent insertion（internal diversion）or percutaneous nephrostomy（external diversion）in the patients suffered from ureteral calculus complicated with urosepsis.Methods From Jan 2011 to Dec 2013,.a total of 63 patients suffered from ureteral calculus complicated with urosepsis were randomized into two groups.In internal diversion group,31 patients underwent double J ureteral stenting,while in external group,.32 patients underwent percutaneous nephrostomy tube insertion.The double J stent was inserted retrograde by using cystoscope or ureteroscope,.while the percutaneous nephrostomy was done under ultrasound guidance.Results The overall success rate of diversion in internal diversion group and external diversion group is 96.8% and 90.6% respectively（P=0.3170）.The time of controlling sepsis after the diversion were（4.6 ±1.9）d and（3.5 ±1.7）d（P =0.0184）.After URL,six patients in the internal diversion group suffered from recurrent urosepsis,and no recurrence of urosepsis in external diversion group（P =0.0287）.One patient progressed to septic shock among those 6 patients in the internal diversion group.Conclusion Both internal and external diversion appear effective in the patients suffered from ureteral calculus complicated with urosepsis,.but external diversion exists a better approach of temporary urinary diversion than internal diversion for management of ureteral calculus complicated with urosepsis.

关 键 词：输尿管结石 尿脓毒血症 双J管置入术 经皮肾穿刺造瘘术 

分 类 号：R693.4[医药卫生—泌尿科学]