经皮肾镜取石术一期治疗上尿路结石合并尿培养阳性的疗效分析

The efficacy of percutaneous nephrolithotomy in the one-stage treatment of upper urinary tract calculus with positive urine culture

目的探讨超声引导的经皮肾镜取石术(PCNL)一期治疗上尿路结石合并尿培养阳性患者的疗效。方法选取六安市中医院2014年8月至2017年5月一期行PCNL治疗上尿路结石的患者120例,按术前尿培养结果分组,阳性患者为A组(35例),阴性患者为B组(85例),比较两组患者脓肾发生率、手术时间、术后血红蛋白下降值、住院天数、结石清除率和并发症发生率。结果 A组脓肾发生率(20.00%)高于B组(4.71%),差异有统计学意义(P<0.05)。两组患者手术时间、术后血红蛋白下降值、住院天数、结石清除率、输血率和系统炎症反应综合征发生率差异均无统计学意义(P>0.05)。两组患者均顺利完成手术,均未出现器官损伤、感染性休克、肾动脉栓塞和死亡等严重并发症。结论超声引导的PCNL一期治疗上尿路结石合并尿培养阳性是有效可行的,但要加强围手术期管理,合理应用有效的抗菌药物。

Objective To investigate the efficacy of ultrasound-guided percutaneous nephrolithotomy（ PCNL） in the one-stage treatment of upper urinary tract calculus with positive urine culture. Methods A retrospective analysis was performed for 120 patients who underwent PCNL under ultrasound guidance between August 2014 and May 2017 in this hospital. According to the results of preoperative urine culture,the patients were divided into two groups： patients with positive urine culture（ group A） and the others with negative urine culture（ group B）. There were 35 patients in group A and 85 patients in group B. The incidence of pyonephrosis,operation time,postoperative hemoglobin decline,postoperative hospital time,stone clearance rate andpostoperative complications were compared between the two groups.Results The incidence of pyonephrosis in group A（ 20. 00%） was higher than that in group B（ 4. 71%）,which had significant difference（ P〈0. 05）. In both groups,there was no statistically significant difference in operation time,postoperative hemoglobin decline,postoperative hospital time,stone clearance rate,blood transfusion requirement and incidence of systemic inflammatory response syndrome（ SIRS）（ P〈0. 05）. PCNL in both groups were successfully completed,andthere were no other severe complications such as organ damage,septic shock,renal artery embolism and death. Conclusion Ultrasound-guided PCNL in the one-stage treatment of upper urinary tract calculus with positive urine culture is effective. However,perioperative management shoud be enhanced and effective antibiotics should be used.