一期经尿道输尿管镜碎石术治疗输尿管结石继发隐匿性梗阻性肾积脓的疗效和安全性  

The efficacy and safety of one-stage transurethral ureteroscopic lithotripsy for the management of ureteral calculi with secondary silent obstructive pyonephrosis

作　　者：王田 洪欣 柳青 王晓峰[1] Wang Tian;Hong Xin;Liu Qing;Wang Xiaofeng(Department of Urology,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院泌尿外科,102206

出　　处：《中华泌尿外科杂志》2020年第11期846-850,共5页Chinese Journal of Urology

摘　　要：目的探讨一期经尿道输尿管镜碎石术治疗输尿管结石继发隐匿性梗阻性肾积脓的疗效和安全性。方法回顾性分析北京大学国际医院2018年1月至2020年5月行输尿管镜碎石术的32例输尿管结石继发隐匿性梗阻性肾积脓患者的临床资料。男27例,女5例;中位年龄39.5(18~76)岁。结石位于左侧23例,右侧9例。结石体积中位值138.84(33.28~866.32)mm3。所有患者术前均无发热症状且术前血常规、尿常规、尿细菌培养均未提示明显感染。32例均行一期输尿管镜碎石术,术中发现结石梗阻部位以上积脓,留取脓尿行尿常规及尿细菌培养检查。通过吸引器低压吸净脓液,下调水泵灌注压力和流量,间断低压低流量灌注并配合负压吸引,完成碎石术。术后常规留置输尿管双J管,并予抗感染治疗。术后第2天复查腹部X线片,拔除双J管后4~6周复查泌尿系CT或B超,评价结石清除率。根据全身炎症反应综合征(SIRS)发生情况和序贯性器官衰竭评估(SOFA)量表,评价术后感染情况,并根据Clavein Dindo分级系统进行并发症分级,评价手术安全性。结果32例中28例完成一期碎石术,一期结石清除率87.5%,中位手术时间28(11~66)min。2例碎石过程中结石主体返回肾脏,1例输尿管条件较差,1例术中视野不清,此4例均留置双J管结束手术,行二期输尿管镜或输尿管软镜碎石术,均清除结石。术中留取脓尿常规检查结果示,细菌计数中位值295(46~2488)个/μl;白细胞计数中位值160.5(57~7863)个/μl。脓液细菌培养结果示,22例无细菌生长,10例细菌生长。术后发热1例,血细菌培养结果阴性,经对症抗感染治疗1 d后体温恢复正常。术后6例出现SIRS,无脓毒血症发生,无Clavein Dindo≥Ⅲ级并发症发生。结论一期经尿道输尿管镜碎石术治疗输尿管结石继发隐匿性梗阻性肾积脓,对于经严格选择的患者结石清除率高,无严重术后并发症。术中应尽可能降低灌Objective To explore the efficacy and safety of one-stage transurethral ureteroscopic lithotripsy for the management of ureteral calculi with secondary silent obstructive pyonephrosis.Methods Retrospective analysis was performed on the clinical data of 32 cases who had ureteral calculi with secondary silent obstructive pyonephrosis and underwent one-stage transurethral ureteroscopic lithotripsy in Peking University International Hospital from January 2018 to May 2020.Of all the 32 patients,27 were males and 5 were females,with median age of 39.5 years,ranged from 18 years to 76 years.The distribution of stone location included left side in 23 cases and right side in 9 cases.The median stone volume was 138.84 mm3,ranged from 33.28 mm3 to 866.32 mm3.All patients had no fever before surgery,and no obvious infection was indicated by preoperative blood routine,urine routine and urine bacterial culture.All patients underwent one-stage transurethral ureteroscopic lithotripsy and the dignosis of pyonephrosis was made intraoperatively.Purulent urine was collected during the operation for urine routine and bacterial culture test.We first suck out the pus at low pressure through an aspirator,and then turned down the perfusion pressure and flow to the lowest value of the pump.Intermittent low pressure and low flow perfusion combined with negative pressure suction were maintained during the subsequent lithotriptic operation.The double J stent must be indwelt routinely at the end of the operation,and anti-infective drug therapy was started postoperatively.We evaluated the stone free rate by rechecking KUB on the second day after the operation,and urinary CT scan or color ultrasound examination 4-6 weeks after the double J stent was removed.Postoperative infection was evaluated according to the incidence of systemic inflammatory response syndrome(SIRS)and the score of sequential organ failure assessment(SOFA)scale.Complications were graded by a Clavein-Dindo system to evaluate the safety of surgery.Results All 32 patients under

关 键 词：输尿管结石 隐匿性肾积脓 输尿管镜 疗效 

分 类 号：R699.4[医药卫生—泌尿科学]