即刻引流对上尿路结石伴感染的临床意义

The significance of the immediate drainage in urinary stones with infection

目的 探讨尽早（即刻）引流对上尿路结石伴感染治疗中的必要性和重要性及安全性.方法 分析2015年12月至2016年12月收治入院的45例上尿路结石伴感染的患者临床资料.其中22例行患侧经皮肾镜微造瘘引流,23例患者行患侧输尿管支架植入术.45例患者入院均伴不同程度发热,血常规白细胞、中性粒细胞百分比（NEU％）、C-反应蛋白（CRP）、血清降钙素原（PCT）、尿常规白细胞均升高,泌尿系CT提示患侧肾周不同程度渗出.所有患者入院完善术前检查后2～24h内均行局麻下患侧经皮肾镜微造瘘引流或膀胱镜下患侧输尿管支架植入术,感染控制后Ⅱ期腔内手术碎石治疗.结果 所有患者均顺利完成手术.术前体温（38.60 ±0.87）℃,术后第1天（38.10±0.53）℃,术后第2天体温（37.60 ±0.36）℃,术后第3天体温（36.80 ±0.21）℃,术前、后体温比较,差异均有统计学意义（P＜0.05）.术前血常规白细胞（18.2土1.2）×109/L,术后3 d（5.6±1.4）×109/L,差异有统计学意义（P＜0.05）;术前中性粒细胞百分比（91.3±4.1）％,术后第3天（65.2±6.2）％,差异有统计学意义（P＜0.05）;术前CRP （96.3 ±21.4） mg/L,术后第3天（21.30 ±3.20） mg/L,差异有统计学意义（P＜0.05）;术前PCT （8.3 ±2.2）,术后第3天（0.07 ±0.01）,差异有统计学意义（P＜0.05）.所有患者均无感染性休克发生.结论 即刻引流对上尿路结石伴感染至关重要,可尽快控制感染,减少感染性休克发生.

Objective To discuss drainage as soon as possible for the treatment of urinary stones with infection on the necessity and importance and security.Methods Between December 2015 and December 2016,clinical data of 45 patients with urinary stones with infection were analyzed,22 patients were treated by percutaneous nephroscope and 23 cases of patients underwent ureteral stent implantation.All patients admitted to hospital with different degree of fever,different degrees of perirenal exudation in the affected sides of the patients and routine blood WBC,neutrophil percentage （NEU％）,C-reactive protein（CRP）,Serum procalcitonin（PCT）,higher routine urine white blood cells increased.All patients were performed micro-colostomy drainage under local anesthesia by percutaneous nephroscope or ureteral stent implantation under cystoscope within 2-24 h after preoperative examination,and stage Ⅱ endoscopic lithotripsy after controlling infection.Results All patients were successfully completed surgery.Preoperative temperature （38.60 ± 0.87） ℃,the third day after the body temperature of （36.80 ± 0.21） ℃ were found,compared with preoperative body temperature,there was significant difference（P ＜0.05）.Preoperative routine blood leukocytes was （18.2 ± 1.2） ×109/L,three days after treatment was （5.6 ± 1.4） × 109/L,there was significant difference （P ＜ 0.05）.There was significant difference in neutrophil percentage,CRP and PCT preoperation and third day after operation[（91.3 ±4.1）％ vs.（65.2 ±6.2）％,（96.3 ±21.4） mg/L vs.（21.3 ±3.2） mg/L,（8.3 ± 2.2） vs.（0.07 ± 0.01）,P ＜ 0.05].No septic shock occurred in all patients.Conclusions Immediate drainage on urinary stones with infection is crucial,it should control infection as soon as possible to reduce the incidence of septic shock.