孤立肾结石患者电子输尿管软镜钬激光碎石术后出现尿脓毒血症的诊治分析

Diagnosis and treatment of postoperative urosepsis following digital flexible ureteroscopy with holmium laser lithotripsy for solitary kidney calculi

目的：探讨孤立肾结石患者接受电子输尿管软镜钬激光碎石术后出现尿脓毒血症的临床特点及治疗方法。方法：回顾性分析孤立肾结石患者行电子输尿管软镜钬激光碎石术后出现尿脓毒血症的5例患者的临床资料：2例为单侧肾切除术后，3例为功能性孤立肾。结石位于肾下盏3例，多。肾盏2例；结石大小20-31mm，平均25mm。术前3例患者尿培养阳性，其中2例为大肠埃希氏菌，1例为克雷伯杆菌。患者经由同一术者在全麻下行电子输尿管软镜钬激光碎石术。结果：5例患者术后出现不同程度尿脓毒血症。经及时进行有效液体复苏，选用敏感抗生素或亚胺培南，并选用小剂量短期地塞米松及血管活性药物等对症支持治疗，术后I周内均逐渐恢复，痊愈出院。结论：尿脓毒血症是上尿路结石腔内治疗后的严重并发症之一。充分的术前准备，熟练的手术操作，严密的术后监测，早期发现和及时有效的治疗，是防治孤立肾结石电子输尿管软镜钬激光碎石术后出现尿脓毒血症的有效措施。

Objective： To investigate the clinical features and treatment of postoperative urosepsis following digital flexible ureteroscopy with holmium laser lithotripsy for solitary kidney calculi. Method：Clinical data of five cases with postoperative urosepsis following digital flexible ureteroscopy with holmium laser lithotripsy for solitary kidney calculi were retrospectively analyzed. Two of them underwent unilateral nephrectomy, and the other three were diagnosed of functional solitary kidney. Three patients have lower calyx calculi, and two patients have multi- ple renal calyx calculi. The size of stones was 20-31 （average, 25） mm. Preoperative urine culture of three cases were positive, including two cases of E. coli, one case of Klebsiella. Five cases were all performed digital flexible ureteroscopy with holmium laser lithotripsy under general anesthesia by the same surgeon. Result： All patients de- veloped varying degrees of postoperative urosepsis. However, all of them recovered well and discharged a week later postoperatively for they accepted the timely and effective fluid resuscitation, sensitive antibiotics or imipen- em, short-term use of small doses of dexamethasone, vasoactive drugs and other symptomatic and suppoi-tive treatment. Conclusion：Urosepsis is one of the serious complications after minimally invasive lithotripsy for upper u- rinary tract calculi. However, interventions including adequate preoperative preparation, skilled operation, post- operative close monitoring, early detection and timely treatment were effective for prevention and treatment of postoperative urosepsis following digital flexible ureteroscopy with holmium laser lithotripsy for solitary kidney calculi.