术前肾穿刺造瘘减少(轻)输尿管镜钬激光碎石术后感染作用的研究

Effect of Nephrostomy on Infections Caused by Ureteroscopic Holmium Laser Lithotripsy

目的探讨术前肾穿刺造瘘减少或减轻输尿管镜下钬激光碎石术后感染的作用。方法2007年3月～2008年5月选择100例单侧输尿管上段结石合并肾积水,按患者入院时间顺序编号,单号为对照组(n=50),单纯行输尿管镜下钬激光碎石术,双号为实验组(n=50),术前2d行患侧肾穿刺造瘘术后再行输尿管镜下钬激光碎石术。比较2组患者术后最高体温、体温恢复正常时间、血常规和尿常规恢复正常时间和住院费用。结果实验组患者术后最高体温(37.8±0.5)℃显著低于对照组(38.6±0.5)℃(t=-8.000,P=0.000),体温恢复正常时间(1.6±0.2)d与对照组(2.8±0.4)d相比显著缩短(t=-18.974,P=0.000),血常规恢复正常时间(2.7±0.4)d显著短于对照组(4.1±0.6)d(t=-13.728,P=0.000),尿常规恢复正常时间(3.6±0.6)d显著短于对照组(5.2±0.7)d(t=-12.271,P=0.000),住院费用(0.86±0.15)万元显著少于对照组(0.95±0.11)万元(t=-3.421,P=0.000)。结论术前肾穿刺造瘘对伴有肾积水的输尿管上段结石患者减少或减轻术后感染及降低医疗费用有积极作用。

Objective To investigate the effect of nephrostomy on the infections after ureteroscopic holmium laser lithotripsy. Methods From March 2007 to May 2008, 100 patients with unilateral upper ureteral calculi complicated with hydronephrosis were divided into control and experiment groups according the patients number （50 cases in each）. Ureteroscopic holmium laser lithotripsy was carried out in the control group, while in the experiment group, nephrostomy was performed two days prior to ureteroscopic holmium laser lithotripsy. The clinical data including highest body temperature after the operation, recovery of body temperature, blood routine and urine routine, as well as hospital cost, were compared between the two groups. Results Compared with the control group, patients in the experiment group showed significantly lower highest temperature [ （37.8 ± 0.5 ）℃ vs （38.6 ± 0.5 ）℃ , t = - 8. 000, P = 0. 000 ] , quicker recovery of body temperature [ （ 1.6 ± 0.2） d vs （2.8 ± 0.4） d, t = - 18. 974, P = 0. 000 ], blood routine [（2.7 ±0.4） dvs （4.1 ±0.6） d, t= -13.728, P=0.000], and urine routine [（3.6 ±0.6） d vs （5.2 ±0.7） d, t= -12.271, P=0.000], as well as lower hospital cost [（8.6±1.5） thousand RMB vs （9.5±1.1） thousand RMB, t= -3.421, P = 0. 000 ]. Conclusion Nephrostomy shows positive effect on relieving infections after ureteroscopic holmium laser lithotripsy.