上尿路结石腔镜治疗中围手术期感染的防治策略

Prevention strategies of around-operative infection in endoscopic treatment for upper urinary tract stones

感染是结石腔镜治疗围手术期最常见、最严重的并发症。感染的原因复杂多样,结石本身及术中造成的肾内压升高都是引起感染的重要原因。近年来,病原体检测的相关研究表明,术中结石细菌培养相比术前尿细菌培养,对术后抗生素的选择更具指导意义。同时,对上尿路结石患者细菌谱和药敏情况的分析,也为那些没有病原学检测结果的患者提供了可靠的经验性用药方案。在加强抗感染治疗的同时,术前完善的准备,术中减少损伤、降低肾盂内压、保证引流通畅,术后积极的支持治疗等各个方面也都是控制感染的重要因素。

Infection is the most common and serious perioperative complication of endoscopic therapy for urinary stones. The causes of the infection are complicated, which include the stones and the increased intrapelvic pressure happened intraoperatively. In recent years, many researches concerning pathogen detection showed that intraoperative stone culture had more important and referenced value to antibiotic choosing postoperatively compared with preoperative urine culture. And, the analyses of bacterial spectrum and drug sensitivity tests for patients suffered from upper urinary tract stone provided a reliable empirical therapy for patients without pathogen detection results. Besides anti-infection treatment, it is important to perfect preoperative preparation, decrease injury during operation, reduce intrapelvic pressure, keep drainage unobstructed and offer active supportive therapy after operation in infection control.