早期逆行置入双J管引流术和经皮肾穿刺造瘘引流术急诊处理 输尿管结石梗阻合并尿脓毒血症的效果  

Effect of early retrograde double J-tube drainage and percutaneous nephrostomy and drainage in emergency treatment of ureteral calculi obstruction complicated with urinary sepsis

作　　者：王咸钟[1] WANG Xianzhong(Department of Urology,Guangyuan City Central Hospital,Guangyuan Sichuan 628000,China)

机构地区：[1]广元市中心医院泌尿外科,四川广元628000

出　　处：《临床与病理杂志》2020年第7期1757-1762,共6页Journal of Clinical and Pathological Research

摘　　要：目的:探讨早期逆行置入双J管引流术和经皮肾穿刺造瘘引流术在输尿管结石梗阻合并尿脓毒血症急诊处理的应用价值。方法:回顾性分析本院泌尿外科2016年9月至2019年2月期间74例输尿管结石梗阻合并尿脓毒血症的临床资料,其中44例行早期输尿管镜直视下逆行置入双J管引流术急诊处理,记为双J管引流组,另外30例行B超引导下经皮肾穿刺造瘘引流术急诊处理,记为穿刺造瘘引流组。比较两组患者一般资料、引流成功率、脓毒血症控制时间、并发症以及II期碎石情况。结果:两组患者术前相关资料比较,差异均无统计学意义(P>0.05);双J管引流组引流成功率100.00%(44/44)明显高于穿刺造瘘引流组80.00%(24/30),差异有统计学意义(χ2=9.577,P<0.05),双J管引流组尿脓毒血症好转时间(6.49±1.30) d和穿刺造瘘引流组(6.53±1.29) d比较,差异无统计学意义(t=0.098,P>0.05)。两组术后均无输尿管损伤、穿孔、周围脏器受损、大出血或感染性休克发生,术后均成功行II期碎石术,术后恢复良好。结论:早期逆行置入双J管引流术和经皮肾穿刺造瘘引流术急诊处理输尿管结石梗阻合并尿脓毒血症均安全有效;与经皮肾穿刺造瘘引流术相比,输尿管镜下逆行置入双J管引流术置管引流成功率更高,技术难度小,临床实际中可根据医师的操作经验和患者肾积水程度等具体情况酌情选择。Objective:To explore the value of early retrograde double J tube drainage and percutaneous nephrostomy drainage in the emergency treatment of ureteral calculi obstruction complicated with urinary sepsis.Methods:The clinical data of 74 cases of ureteral calculi obstruction complicated with urinary sepsis in our urology department from September 2016 to February 2019 were retrospectively analyzed.Forty-four cases were treated with early ureteroscopic retrograde double J-tube drainage under direct vision.They were classified as double J-tube drainage group,and 30 cases were treated with percutaneous nephrostomy and fistula drainage under B-ultrasound guidance.Emergency treatment was recorded as puncture and fistula drainage group.The general information,success rate of drainage,control time of sepsis,complications and stage II lithotripsy were compared between the two groups.Results:There was no significant difference in preoperative data between the 2 groups(P>0.05).The success rate of double J tube drainage group[100.00%(44/44)]was significantly higher than that of puncture and fistula drainage group[80.00%(24/30)].The difference was statistically significant(χ2=9.577,P<0.05).There was no significant difference in the improvement time of urinary sepsis between double J tube drainage group[(6.49±1.30)d]and puncture fistula drainage group[(6.53±1.29)d;t=0.098,P>0.05].No ureteral injury,perforation,peripheral organ damage,massive hemorrhage or septic shock occurred in the 2 groups.Phase II lithotripsy was successfully performed after operation,and the recovery was good.Conclusion:Early retrograde double J-tube drainage and percutaneous nephrostomy and drainage are safe and effective in emergency treatment of ureteral calculi obstruction complicated with urinary sepsis.Compared with percutaneous nephrostomy and drainage,retrograde double J-tube drainage under ureteroscope has higher success rate and less technical difficulty.Clinical practice can be selected according to the doctor’s operating experience and the

关 键 词：输尿管结石梗阻 尿脓毒血症 输尿管镜 双J管引流术 经皮肾穿刺造瘘引流术 Ⅱ期碎石术 

分 类 号：R699[医药卫生—泌尿科学]