上尿路梗阻伴尿脓毒症急诊微创治疗的临床研究

Clinical study on emergency minimally invasive treatment of urine sepsis with upper urinary tract obstruction

目的对上尿路梗阻伴尿脓毒症急诊微创治疗的临床效果进行分析研究。方法收集本院泌尿科2013年10月~2015年11月诊治的75例上尿路梗阻伴尿脓毒症患者,根据治疗方式不同分为两组,治疗组给予输尿管镜直视下逆行置入双J管引流术,参照组给予B超引导下经皮肾穿刺造瘘术,观察最终的治疗效果。结果 （1）治疗组引流成功率为94.9%（37/39）显著高于参照组的72.2%（26/36）,差异具有统计学意义（x2=7.15,P〈0.05）;（2）治疗组患者尿脓毒症控制时间（6.1±1.14）d显著短于参照组的（8.5±2.4）d,差异具有统计学意义（t=3.618,P〈0.05）;（3）治疗组患者并发症发生率7.7%（3/39）显著低于参照组的27.8%（10/36）,差异具有统计学意义（x2=5.27,P〈0.05）。结论输尿管镜直视下逆行置入双J管引流术这种急诊微创治疗方法应用于上尿路梗阻伴尿脓毒症患者中的效果确切,能够大大提高引流成功率以及降低并发症发生率,对缩短尿脓毒症控制时间具有十分重要的作用和意义。

Objective To analyze the clinical effect of emergency minimally invasive treatment of urine sepsis with.upper urinary tract obstruction. Methods From October 2013 to November 2015, 75 patients of upper urinary tract obstruction with urine sepsis in our hospital urology department were collected. All the patients were divided into two groups according to different treatment, the patients in treatment group were given under ureteroscopy look straight into the retrograde placing double J tube drainage, the patients in control group were given under ultrasound guided percutaneous renal biopsy colostomy, all the treatment effect of two groups were observed after treatment. Results（1）In treatment group, the success rate of drainage was 94.9%（37/39）, and was significantly higher than that of the control group of 72.2%（26/36）, the difference was significant（x2=7.15,P〈0.05）.（2）In treatment group, the control time of suffering from urinary sepsis was（6.1±1.14）d, and significantly shorter than that of the control group of（8.5±2.4）d, the difference was significant（t=3.618, P〈0.05）.（3）In treatment group, the complication rate was 7.7%（3/39）, and significantly lower than that of the control group of 27.8%（10/36） respectively. the difference was significant（x2=5.27, P〈0.05）. Conclusion Ureteroscopy under direct vision into retrograde double-J tube drainage of such emergency minimally invasive treatment method has exact effect apply to the patients of upper urinary tract obstruction with urinary sepsis, and can greatly improve the success rate of drainage and reduce the incidence of complications, has the effect of shortening the urinary sepsis and control time is very important.