经皮肾造瘘与输尿管支架置入治疗尿源性脓毒症的疗效比较  

Comparison of the therapeutic effect between percutaneous nephrostomy and ureteral stent placement in the urinary sepsis

作　　者：张剑平[1] 林荣凯[1] 洪梓煌 朱凌峰 ZHANG Jianping;LIN Rongkai;HONG Zihuang;ZHU Lingfeng(Department of Urology,Affiliated Haixia Hospital of Huaqiao University,910th Hospital of PLA,Quanzhou,Fujian,362000,China;Department of Urology,the Second Affiliated Hospital of Hainan Medical College)

机构地区：[1]华侨大学附属海峡医院(解放军第九一〇医院)泌尿外科,福建泉州362000 [2]海南医学院附属第二医院泌尿外科

出　　处：《临床泌尿外科杂志》2023年第10期791-795,共5页Journal of Clinical Urology

基　　金：福建省泉州市科技项目(No:2018Z143)。

摘　　要：目的:比较微通道经皮肾造瘘术与经尿道输尿管内支架管置入引流输尿管结石所致感染性肾内积液的临床疗效,探讨肾盂积液CT值在早期干预尿源性脓毒症的临床价值。方法:收集2015年1月—2021年11月我院收治的上尿路结石所致尿源性脓毒症患者110例,其中行经尿道输尿管支架管置入(输尿管支架组)54例,行B超引导下微通道经皮肾造瘘术(肾造瘘组)56例。比较2种治疗方案的手术时间、置管成功率、感染控制时间、引流液细菌培养阳性率及手术安全性等。以肾盂积液CT值12 HU为界,比较2种方案的感染控制时间。结果:肾造瘘组平均手术时间为(17.04±5.49) min、平均感染控制时间为(5.41±0.93)d,均显著少于输尿管支架组的(26.74±8.0) min、(6.26±0.94) d,差异有统计学意义(P<0.05);肾造瘘组引流液培养阳性率显著高于输尿管支架组,差异有统计学意义(P<0.05)。以肾盂积液CT值12 HU为界,当肾盂CT值<12 HU时,2组感染控制时间差异无统计学意义(P>0.05);当肾盂CT值≥12 HU时,肾造瘘组感染控制时间为5.29 d,显著低于输尿管支架组的6.67 d(P<0.05)。结论:经皮肾穿刺造瘘和输尿管内引流对于输尿管结石所致脓毒症均有良好效果。对于肾盂积液CT值≥12 HU,经皮肾微通道造瘘疗效优于输尿管内支架管置入引流,更适合于尿源性脓毒症的早期引流。Objective:To compare the clinical efficacy between nephrostomy and ureteral stent placement in the treatment of ureteral calculi-induced urinary sepsis,and to explore the clinical value of CT value of renal pelvic effusion in early intervention of urinary sepsis.Methods:We collected 110patients with urinary sepsis caused by ureteral stones who were admitted to the Haixia Hospital of Huaqiao University from January 2015to November 2021.Fifty-four cases underwent ureteral stent placement(USP)and the other 56cases underwent minimal invasive percutaneous nephrostomy(MIPN)under ultrasound guidance.Clinical data including the operation time,infection control time,positive rate of bacterial culture,surgical safety were compared between two groups.CT value of renal effusion of 12HU was set as critical value,then the duration from intervention to the point when sepsis was under control between the two groups was compared.Results:The operation time of the MIPN group was less than that of the other group([17.04±5.49]min vs[26.74±8.0]min,P<0.05),and the infection control duration in MIPN group was less than that of the other group([5.41±0.93]d vs[6.26±0.94]d,P<0.05).The difference between two groups was statistically significant(P<0.05).The positive rate of urine culture in the MIPN group was higher than that in the USP group,and the difference was statistically significant(P<0.05).In our investigation,the CT value 12HU of renal pelvis effusion was set as the critical value.When patients’CT values were less than 12HU,there was no significant difference of infection control duration between the two groups(P>0.05),while the CT value of renal pelvic effusion>12HU,the infection control duration of the nephrostomy group was less than the other group(5.29vs 6.67days,P<0.05).Conclusion:Percutaneous nephrostomyand ureteral drainage were both effective for the treatment of sepsis secondary to ureteral calculi.In the patientswhose CT value of renal pelvis effusion greater than 12HU,MIPN was more effective than USP as an clinical

关 键 词：经皮肾穿刺造瘘 输尿管内支架管 CT值 脓毒症 

分 类 号：R691.3[医药卫生—泌尿科学]