经皮肾穿刺造瘘术在输尿管结石合并尿脓毒血症中应用的临床研究

Clinical study of percutaneous nephrostomy in the treatment of ureteral calculus combined with urine sepsis

目的 探讨经皮肾穿刺造瘘术治疗输尿管结石合并尿脓毒血症对预防感染性休克的可行性及安全性分析.方法 对本院201 1年1月至2014年12月输尿管结石合并尿脓毒血症患者46例,在积极抗感染治疗的同时,行经皮肾穿刺造瘘术外引流,观察和分析患者经皮肾穿刺造瘘术前2h和术后48h血白细胞计数（WBC）、中性粒细胞比例（NEUR）、C反应蛋白（CRP）、降钙素原（PCT）等感染性指标变化情况以及行输尿管镜碎石术后尿脓毒血症及感染性休克发生情况.结果 46例患者中,44例顺利行经皮肾穿刺造瘘术外引流,2例行输尿管镜下双J管置入内引流术.术后48h复查血WBC、NEUR、CRP和PCT感染性指标均较前术前2h明显下降差异有统计学意义.44例经皮肾穿刺造瘘术患者待感染控制及引流充分后再行输尿管镜碎石术,术后无1例出现感染性休克.结论 对于输尿管结石合并尿脓毒血症患者,采取经皮肾穿刺造瘘术外引流和积极的抗感染治疗,有利于预防输尿管镜碎石术后感染性休克和严重感染性并发症的发生.

Objectives To investigate the feasibility and safety of percutaneous nephrostomy in the prevention of septic shock before the surgery for ureteral calculus combined with urosepsis.Methods 46 patients with ureteral calculus combined with urosepsis in our hospital from Janaury 2011 to December 2014 were accepted by anti-infection treatment and percutaneous nephrostomy.Before the ureteroscopic holmium laser lithotripsy （URL）,all the patients were underwent the drainage.The clinical data,such as WBC,NEUR,CRP and PCT from the patients were analyzed before and after percutaneous nephrostomy.Results 44 patients underwent the drainage by percutaneous nephrostomy,and other 2 patients underwent the drainage by intra-ureteral cannula with ureteroscope successfully.All the infection indicators above-mentioned were decreased,and the difference was statistically significant.No septic shock and other severe complications happened after the URL.Conclusions The drainage by percutaneous nephrostomy and aggressive anti-infection treatment for patients with ureteral calculus combined with urosepsis is effective for proventing septic shock before URL.