急性输尿管结石梗阻合并严重感染的微创治疗

Minimally invasive treatment for acute ureteric calculi obstruction complicated with severe infection

目的探讨急性输尿管结石梗阻合并严重感染的治疗方法与疗效。方法对68例急性上尿路梗阻合并严重感染的患者在积极抗感染治疗的同时，急诊行输尿管镜下逆行插管置管引流术、输尿管结石钬激光碎石术及超声引导下行经皮肾穿刺造瘘术置管引流，感染控制后行体外冲击波碎石或二期原通道超声碎石取石术。结果13例逆行插管成功，34例行钬激光碎石后留置双J管引流，21例行肾穿刺造瘘引流，控制感染后二期采用EMS清石系统行原通道超声碎石取石。术后18例出现一过性高热、寒颤、血象升高、败血症感染性体克症状，经抗炎、对症治疗后好转；47例置入双J管引流的患者中有2例出现双J管堵塞，给予更换双J管；插管的13例患者有7例结石自行排出，3例体外冲击波碎石，3例二期行钬激光碎石。术后3个月复查，68例患者结石均排出，无结石残留，患者肾功能均恢复正常。结论采用经皮肾穿刺造瘘或输尿管钬激光碎石术及置管引流术等解除梗阻是治疗合并感染的急性上尿路梗阻的首选治疗方法。

Objective To investigate the therapeutic methods and effect of acute ureteric calculi obstruction complicated with severe infection. Methods Sixty-eight cases of acute upper urinary tract obstruction complicated with severe infection were choosed. They were treated with anti-infection treatment actively, and at the same time, the emergency ureteroscopic retrograde intubation tube drainage, ureteral calculi with holmium： YAG laser lithotripsy or ultrasound guided percutaneous nephrostomy tube drainage, extracorporeal shock wave lithotripsy or two period the original channel ultrasonic lithotripsy lithotomy were given after infection controlled. Results Thirteen cases had success of retrograde intubation, 34 cases underwent holmium laser lithotripsy and indwelling double J tube drainage, 21 cases underwent nephrostomy drainage, and were cuered by two period ultrasonic lithotripsy using EMS stone system after infection controlled. Eighteen patients suffered from high fever, chills, blood cells increased, sepsis septic shock symptoms, and were cured after the anti-inflammatory, symptomatic treatment. Among the 47 patients who had implantation of double J tube drainage, 2 cases had double J tube blockage, and were given the replacement of double J tube; Among the 13 patients with intubation,7 cases had self discharge, 3 cases had extracorporeal shock wave lithotripsy, 3 patients had stage two holmium laser lithotripsy. By reexamination 3 months after operation, stones were discharged is all of the 68 cases without residual calculus, and their renal function returned to normal. Conclusions Percutaneous nephrostomy, ureter holmium laser lithotripsy, tube drainage and relief of the obstruction is the prefered methods for acute upper urinary tract obstruction complicated with severe infection.