输尿管结石梗阻并发尿脓毒血症45例早期急诊处理经验总结  

Summary of experience in early emergency treatment of 45 cases of ureteral calculus obstruction complicated with urinary sepsis

作　　者：聂军 黄鑫 罗卫平 蒋科 杭震宇 NIE Jun;HUANG Xin;LUO Weiping;JIANG Ke;HANG Zhenyu(Urology Department,Liyang Branch of Jiangsu Provincial People's Hospital/Liyang People's Hospital,Liyang 213300,China)

机构地区：[1]江苏省人民医院溧阳分院/溧阳市人民医院泌尿外科,江苏溧阳213300

出　　处：《临床医学研究与实践》2023年第35期5-8,共4页Clinical Research and Practice

摘　　要：目的总结输尿管结石梗阻并发尿脓毒血症的急诊处理经验,介绍提高急诊置管引流成功率的操作要点,分析经尿道输尿管镜下逆行置入双J管内引流术与CT引导下经皮肾穿刺造瘘外引流术的有效性及安全性。方法回顾性分析2018年5月至2022年5月我院收治的45例输尿管结石梗阻并发尿脓毒血症病例,均采用一期置管引流,待病情平稳后二期处理输尿管结石的治疗策略,其中37例患者采用经尿道输尿管镜下逆行置入双J管内引流术,8例行CT引导下经皮肾穿刺造瘘外引流术。通过分析术前2 h、术后48 h患者的白细胞计数、中心粒细胞百分比、C-反应蛋白、降钙素原等指标的变化,评估两种早期急诊处理方案的有效性及安全性。结果45例患者均成功置管引流,未出现输尿管损伤穿孔、大出血及周围脏器损伤等严重并发症;术后48 h的白细胞计数、中心粒细胞百分比、C-反应蛋白、降钙素原均较术前2 h明显好转(P<0.05);待病情平稳后二期选择合适的方案处理结石,所有患者的结石基本清除完全,除1例住院时间超30 d,其余44例患者的平均住院时间为(10.60±2.90)d。结论输尿管结石梗阻并发尿脓毒血症是临床危急重症,早期发现、早期干预及治疗是治疗成功的关键。经尿道输尿管镜下逆行置入双J管内引流术及CT引导下经皮肾穿刺造瘘外引流术是急诊处理输尿管结石梗阻并发尿脓毒血症安全、有效的方案,值得在基层医院推广应用。Objective To summarize the experience of emergency treatment of ureteral calculus obstruction complicated with urinary sepsis,introduce the operation points to improve the success rate of emergency catheter drainage,and analyze the efficacy and safety of transurethral ureteroscopic retrograde placement of double J tube drainage and CT-guided percutaneous nephrostomy external drainage.Methods A retrospective analysis of 45 cases of ureteral calculus obstruction complicated with urinary sepsis admitted in our hospital from May 2018 to May 2022 was performed.All patients were treated with one-stage catheter drainage.After the condition was stable,the treatment strategy of ureteral calculus was treated in the second stage.Among them,37 patients were treated with transurethral ureteroscopic retrograde placement of double J tube drainage,and 8 patients were treated with CT-guided percutaneous nephrostomy external drainage.By analyzing the changes of white blood cell count,central granulocyte percentage,C-reactive protein and procalcitonin at 2 h before operation and 48 h after operation,the efficacy and safety of the two early emergency treatment schemes were evaluated.Results All the 45 patients were successfully treated with catheter drainage,and no serious complications such as ureteral injury perforation,massive hemorrhage and peripheral organ injury occurred;the white blood cell count,central granulocyte percentage,C-reactive protein and procalcitonin significantly improved at 48 h after operation compared with 2 h before operation(P<0.05);after the condition was stable,the appropriate scheme was selected to treat the stones in the second stage.The stones of all patients were basically completely removed.Except for 1 case with hospitalization time exceeding 30 d,the average hospitalization time of the remaining 44 patients was(10.60±2.90)d.Conclusion Ureteral calculus obstruction complicated with urinary sepsis is a clinical critical disease.Early detection,early intervention and treatment are the key to successf

关 键 词：输尿管结石 尿脓毒血症 双J管置管 肾穿刺造瘘 

分 类 号：R459.7[医药卫生—急诊医学]