输尿管结石梗阻合并急性上尿路重度感染的微创治疗

Minimally Invasive Treatment for Ureteric Calculi Obstruction Complicated with Acute Upper Urinary Tract Infection

目的探讨微创技术治疗输尿管结石梗阻合并急性上尿路重度感染的临床疗效。方法选取2013年1月—2015年12月间,对56例输尿管结石梗阻合并急性上尿路重度感染患者行微创手术治疗。在积极抗感染、纠正败血症和电解质紊乱的同时,急诊行输尿管镜下置管引流或输尿管镜钬激光碎石术引流。感染控制后行输尿管镜下碎石或输尿管软镜下碎石术。结果 23例行输尿管镜碎石术,33例行输尿管镜下逆行置管。手术均成功解除尿路梗阻。术中无输尿管穿孔、大出血、气胸、尿外渗、肾周血肿腹腔脏器损伤等并发症发生。术后3~7 d后,所有患者体温和血白细胞数降至正常。随访6个月,患侧肾积液不同程度减轻。结论输尿管镜下置管引流或输尿管镜钬激光碎石术可迅速控制感染,减少并发症,是输尿管结石梗阻合并急性上尿路重度感染的理想微创治疗方法。

Objective To investigate the clinical effect minimally invasive techniques for treating ureteric calculi obstruction complicated with acute upper urinary tract infection. Methods 56 patients underwent minimally invasive management for ureteric calculi obstruction complicated with acute upper urinary tract infection from Jan. 203 to Dec. 2015. When infection,sepsis,and corrected electrolyte disorders,emergent drainage by retrograde ureteral catheterization using ureteroscopy or ureteroscopic Holmium laser lithotripsy were carried out. Ureteroscopic lithotripsy or flexible ureteroscopic lithotripsy were performed after the infection was controlled. Results 23 patients were treated with ureteroscopic lithotripsy,and 33 cases received retrograde ureteral catheterization using ureteroscopy. All of the patients were treated successfully. There is no severe complication,such as ureteral perforation,massive hemorrhage,pneumothorax,piss exosmosis,perirenal hematomaor and abdominal organ injury ect. The body temperature and blood white cell counts returned to normal ranged 3 to 7 days after operation. All patients were followed up for 6 months,and the renal effusion were relieved. Conclusion Retrograde ureteral catheterization using ureteroscopy or ureteroscopic Holmium laser lithotripsy is efficient for patients with ureteral obstruction and acute severe infection caused by calculi. By using the method,ureteral infection can be controlled quickly without causing severe complications.