输尿管上段嵌顿结石合并感染的病原菌分析与治疗

Distribution of pathogens isolated from impacted upper ureteral calculi patients complicated with infections and clinical treatment

目的探讨输尿管上段嵌顿结石合并感染患者的病原菌分析及临床治疗,为输尿管上段嵌顿结石合并感染的临床诊治提供参考。方法选取2010年1月-2014年10月医院收治的输尿管上段嵌顿结石合并感染患者144例为研究对象,根据患者手术治疗方式的不同将其分为研究组(微创经皮肾镜取石术)和对照组(经尿道输尿管镜气压弹道碎石术),每组72例,患者手术后取结石样本做细菌培养,比较两组患者病原菌分布及耐药性,并对两组患者手术治疗后的相关指标进比较;采用SPSS19.0软件进行数据处理和统计分析。结果 144例患者样本中共培养出病原菌144株,其中革兰阴性菌97株占67.36%,革兰阳性菌44株占30.56%,真菌3株占2.08%;大肠埃希菌、表皮葡萄球菌对氨苄西林、哌拉西林的耐药率较高,均>84.00%;研究组的碎石成功率、术后7、30d的结石清除率、术后辅助治疗率分别为100.00%、97.22%、100.00%、1.39%,显著高于对照组,组间比较差异有统计学意义(P<0.05);研究患者的高热、血培养阳性、血统蛋白降低发生率分别为8.33%、4.17%、1.39%,与对照组患者差异无统计学意义。结论采用微创经皮肾镜取石术的综合疗效显著,能有效清除掉更多结石,显著降低并发症发生率。

OBJECTIVE To investigate the distribution of pathogens isolated from impacted upper ureteral calculi patients complicated with infections and put forward clinical treatment measures so as to provide guidance for clinical diagnosis and treatment of the impacted upper ureteral calculi patients complicated with infections.METHODS A total of 144 impacted upper ureteral calculi patients complicated with infections who were treated in hospitals from Jan 2010 to Oct 2014 were recruited as the study objects and divided into the study group（minimally invasive percutaneous nephrolithotomy）and the control group（transurethral ureteroscopy pneumatic lithotripsy）according to the surgical approach,with 72 cases in each group.The stone samples were collected after the surgeries so as to conduct the bacterial culture,the distribution and drug resistance of the pathogens were compared between the two groups of patients,the related postoperative indicators were observed and compared between the two groups of patients,and the statistical analysis of data was performed with the use of SPSS19.0software.RESULTS Totally 144 strains of pathogens were isolated from 144 samples,including 97（67.36%）strains of gram-negative bacteria,44（30.56%）strains of gram-positive bacteria,and 3（2.08%）strains of fungi.The drug resistance rates of the Escherichia coli,Staphylococcus epidermidis,and Candida albicans to ampicillin and piperacillin were more than84.00%.The success rate of lithotripsy,clearance rate of stones on day 7after the surgery,clearance rate of stones on day 30 after the surgery,and rate of postoperative adjuvant therapy were respectively 100.00%,97.22%,100.00%,and 1.39% in the study group,significantly higher than those in the control group（P〈0.05）.The incidence rates of hyperpyrexia,positive blood culture,and reduced blood protein of the study group were 8.33%,4.17%,and 1.39%,respectively,as compared with the control group,there was no significant difference.CONCLUSION The minimally invasive percutaneous nephrolithotomy can achieve significant clinical effect,clear the stones more effectively,and remarkably reduce the incidence of complications.