妊娠期输尿管结石合并急性肾盂感染置入输尿管双J管治疗效果及安全性分析  

Efficacy and safety of placement of ureteral double-J tubes in treatment of gestational ureteral calculi complicated with acute pelvic infections

作　　者：李斌[1] 俞斌[1] 郑旭东[1] 邵华江[2] 马建婷[2] 刘国楠[3] 

机构地区：[1]余姚市人民医院泌尿外科,浙江余姚315400 [2]余姚市人民医院妇产科,浙江余姚315400 [3]宁波大学医学院,浙江宁波315000

出　　处：《中华医院感染学杂志》2017年第2期414-417,共4页Chinese Journal of Nosocomiology

基　　金：浙江省中西医结合学会科研基金项目(2013LYSX004)

摘　　要：目的分析妊娠期输尿管结石合并急性肾盂感染患者置入输尿管双J管进行治疗的效果及安全性,为临床治疗提供依据。方法选取2011年6月-2016年6月医院收治的行经尿道输尿管镜手术治疗的妊娠期输尿管结石合并急性肾盂感染患者66例,所有患者在给予抗感染治疗的同时采用输尿管镜下置入双J管治疗,部分结石位置较好及术中感染无进一步加重,生命体征稳定者,予以一期行钬激光下碎石取石术,观察其治疗效果及安全性。结果 6例妊娠期输尿管结石合并急性肾盂感染患者在行输尿管镜下置入双J管治疗后,体温在1~4d内恢复正常,白细胞计数在3~6d内恢复正常;与置管前比较,所有患者置管后其C-反应蛋白及前降钙素水平均明显降低,差异均有统计学意义(P<0.05);5例患者术前即出现感染性休克,均及时转入ICU进行抗感染治疗;感染控制后均成功进行了输尿管置管或钬激光碎石治疗,对急性肾盂感染的病因给予解除;所有患者内置双J管2~8个月后进行拔除;对所有患者随访至分娩,其中4例患者自行要求引产,其余患者均顺利生产,且均未发生严重产科并发症。结论妊娠期输尿管结石合并急性肾盂感染置入输尿管双J管治疗安全且有效,尽早采取输尿管双J管置入能够为下一步输尿管结石处理创造有利条件。OBJECTIVE To observe the efficacy and safety of placement of ureteral double-J tubes in treatment of gestational ureteral calculi complicated with acute pelvic infections so as to provide guidance for clinical treatment. METHODS A total of 66 patients with gestational ureteral calculi complicated with acute pelvic infections who received transurethral ureteroscopy from Jun 2011 to Jun 2016 were enrolled in the study, all of the patients received anti-infection therapy and were treated with placement of double-J tubes under ureteroscope at the same time, the stage I holmium laser lithotripsy was conducted for the patients with better stone location, without further exacerbation of intraoperative infection, with stable vital signs, and the curative effect and safety were observed. RESULTS The body temperature of 6 patients with gestational ureteral calculi complicated with acute pelvic infection returned to normal within 1-4 days after the placement of double-J tubes under ureteroscope, the white blood cell counts returned to normal within 3-6 days; the levels of C-reactive protein and procalcitonin were remarkably lower after the intubation than before the intubation, and there was significant difference （P〈0.05）. 5 patients had septic shock before the surgery and were immediately transferred to ICU for anti-infection therapy; ureteral catheterization or holmium laser lithotripsy was successfully conducted after the infection was controlled, the causes of acute pelvic infection were resolved. The inserted double-J tubes of all the patients were removed after 2-8 months. The follow-up was conducted for all of the patients till the delivery, 4 patients voluntarily ordered induced labor, the rest of patients delivered successfully and did not have severe obstetric complications. CONCLUSION The placement of ureteral double-J tubes is safe and effective in treatment of the patients with gestational ureteral calculi complicated with acute pelvic infection, and the insertion of ureteral double-J tubes may facilitat

关 键 词：妊娠期 输尿管结石 急性肾盂感染 置入输尿管双J管 

分 类 号：R714.258[医药卫生—妇产科学]