上尿路菌栓的诊治特点分析

Diagnosis and treatment of bacteria bolt in upper urinary tract

目的提高对上尿路菌栓的认识，探讨其临床诊治方法。方法回顾性分析2005年3月至2012年9月收治11例上尿路菌栓患者的临床资料，总结其临床表现及治疗要点。结果11例患者均分期处理，一期经皮肾穿刺造瘘或逆行放置双J管减压引流，二期10例行经皮肾镜取栓，1例行经尿道输尿管镜取栓。二期手术时间20—55min，平均37min；术中出血10～200ml，平均60m1；10例经皮肾镜者术前血红蛋白94～137g／L，平均119．7g／L，术后48h血红蛋白90～128g／L，平均114．6g／L，与术前比较差异无统计学意义（P〉0．05）。菌栓清除率100％，术后无感染性休克发生。随访3～48个月，平均16个月，未见感染、梗阻等菌栓复发表现。结论上尿路菌栓临床少见，主要表现为感染和梗阻症状，一期减压引流，二期根据菌栓部位选择经皮肾镜或经尿道输尿管镜取栓更安全有效。

Objective To improve the understanding of bacteria bolt in upper urinary tract, and to investigate its diagnosis and treatment. Methods The clinical data of 11 cases with bacteria bolt in upper urinaiy tract were reviewed retrospectively. The clinical manifestation and treatment were summarized. Results Infection and obstruction were the clinical manifestation. Two-stage treatment was provided. Ureter- al stent was indwelled in two cases, and pereutaneous nephrostomy was provided at the first stage in the other 9 cases. Then the bacteria bolt was taken by ureteroscopy （ 1 case） or by percutaneous nephrostomy （ 10 ca- ses） when the condition improved. The second stage operation took 37 rain on average （ranged from 20 to 55）. Estimated blood loss 60 ml on average （ranged from 10 to 200 ml）. Hemoglobin decreased 5.1 g/L （ 3-11 g/L） 48 hours after operation in the 10 cases underwent percutaneous nephrostomy. Bolt-free rate was 100%. There was no infectious shock occurred. No relapse was observed during the 16 mouths of follow-up. Conclusions Bacteria bolt in upper urinary tract is not common. Infection and obstruction are its manifesta- tion. Two-stage treatment is safe and effective.