急性梗阻性尿外渗的诊断和治疗体会

Experience of diagnosis and treatment of acute obstructive urinary extravasation

目的 比较经输尿管镜逆行输尿管置D-J管术和经皮肾穿刺造瘘术治疗急性梗阻性尿外渗的有效性和安全性.方法 2009年1月至2016年1月急性梗阻性尿外渗患者71例,根据当时解除梗阻的方法分为逆行输尿管插管组和经皮肾穿刺造瘘组,分别为45例和26例.观察术后患者肾区叩痛消失和体温恢复正常的时间.结果 经皮肾穿刺造瘘术组和逆行输尿管插管组患者发热患者体温恢复至正常的天数、术后VSA疼痛评分、术后第3 dPCT、CRP分别为[（2.1±1.5）d vs.（3.5±1.6）d]、[（2.9±0.8）分vs.2.2±0.4）分]、[（2.1±0.5） μg/Lvs.（2.6±0.8）μg/L]、[（27.8±8.5） mg/L vs.（35.9±10.4） mg/L）,差异有统计学意义（P＜0.05）;术后肾区叩痛消失的时间分别为[（2.8±1.8）dvs.（3.5±2.1）d],差异无统计学意义（P＞0.05）.逆行输尿管插管组有6例中转行经皮肾穿刺造瘘术,两组均无严重并发症患者.结论 经输尿管镜逆行输尿管置D-J管术和经皮肾穿刺造瘘术治疗急性梗阻性尿外渗是有效和安全的,当患者出现脓毒血症的表现时采用经皮肾穿刺造瘘术引流效果更好.

Objective To compare the efficacy and safety of ureteroscopy retrograde ureteral D-J tube insertion and percutaneous nephrostomy in the treatment of acute obstructive urinary extravasation.Methods 71 patients with acute obstructive urinary extravasation between January 2009 and January 2014 were divided into percutaneous nephrostomy group （26 cases） and retrograde ureteral intubation group （45 cases） according to the way of relieving obstruction.Recorded postoperative renal percussive pain disappearing time and the time of temperature recovery.Results The time of temperature returning to normal of fever patients,VAS score,PCT,CRP of percutaneous nephrostomy group were （2.1±1.5）d,（2.9±0.8）,（2.1±0.5）pg/L,（27.8±8.5）mg/L,those of retrograde ureteral catheterization group were （3.5±1.6）d,（2.2±0.4）,（2.6±0.8）μg/L,（35.9±10.4）mg/L,with statistically significant differences （P〈0.05）;postoperative renal percussive pain disappearing time of percutaneous nephrostomy group was （2.8±1.8）d,that of retrograde ureteral catheterization group was （3.5±2.1）d,without statistically significant difference （P〉0.05）.There were no serious complications in both groups,except 6 patients in retrograde ureteral catheterization group shifted to percutaneous nephrostomy.Conclusion Ureteroscopy retrograde ureteral D-J tube insertion and percutaneous nephrostomy were both effective and safe,while the latter was more effective to relieve obstruction when patients manifasted with sepsis.