逆行置入D-J管治疗上尿路结石尿源性脓毒败血症的临床观察  

A clinical study on retrograde placement of D-J tube in patients with uremic sepsis

作　　者：文瀚东 颜昌智 潘铁军 王涛 李想 WEN Handong;YAN Changzhi;PAN Tiejun;WANG Tao;LI Xiang(Department of Urology,Central War Zone General Hospital of Chinese People's Liberation Amy,Wuhan 430070;The First Clinical Medical College of Southern Medical University,Guangzhou 510515,China)

机构地区：[1]中国人民解放军中部战区总医院泌尿外科,湖北武汉430070 [2]南方医科大学第一临床医学院,广东广州510515

出　　处：《现代泌尿外科杂志》2021年第1期30-32,共3页Journal of Modern Urology

基　　金：国家高技术研究发展“863”计划项目(No.2012AA021102)。

摘　　要：目的探讨如何提高上尿路结石性梗阻引起的尿源性脓毒败血症患者逆行置入D-J管的成功率。方法回顾性分析2012年12月至2019年11月我科采用逆行置入D-J管内引流治疗上尿路结石合并尿源性脓毒败血症的106例患者的临床资料。比较了导丝硬头与导丝软头置入D-J管、膀胱镜与输尿管镜下置入、病程<3 d与>3 d和患者肾积水<2 cm与>2 cm的置管成功率。结果106例患者中100例成功置入D-J管内引流,6例失败改为经皮肾穿刺造瘘引流。在治疗过程中使用导丝软头在输尿管镜下逆行置入D-J管治疗病程短、积水少的患者,疗效更好,差异有统计学意义(P<0.05)。结论治疗上尿路结石尿源性脓毒败血症患者,可优先选择输尿管镜用导丝软头逆行置入D-J管,逆行置管失败时可考虑行经皮肾穿刺造瘘引流。Objective To explore ways of improving the success rate of retrograde placement of D-J tube in patients with uremic sepsis secondary to upper urinary tract calculi.Methods The clinical data of 106 patients with upper urinary tract calculi complicated with uremic sepsis treated during Dec.2012 and Nov.2019 were reviewed.The success rates of D-J tube with hard and soft guide wire,under cystoscopy or ureteroscopy,with course of disease<3 days and>3 days and hydronephrosis<2 cm and>2 cm were analyzed.Results The D-J tube was successfully inserted in 100 cases,and the 6 cases who failed converted to percutaneous nephrostomy.The use of soft guide wire significantly shortened the course of disease,and had better curative effects in patients with little hydronephrosis(P<0.05).Conclusion In the treatment of upper urinary tract calculi with uremic sepsis,retrograde placement of D-J tube with soft guide wire can be the first choice.If retrograde placement fails,percutaneous nephrostomy and drainage can be considered.

关 键 词：尿源性脓毒败血症 上尿路结石 D-J管 

分 类 号：R693[医药卫生—泌尿科学]