后腹腔镜输尿管切开取石术治疗输尿管上段结石合并感染的临床观察

Clinical observation of retroperitoneoseopic ureterolithotomy in the treatment of upper ureteral calculi with infection

目的探讨后腹腔镜下上段输尿管切开取石术治疗输尿管上段结石合并感染的安全性和有效性。方法回顾性分析2015年9月至2018年9月解放军联勤保障部队九一〇医院73例输尿管上段结石合并感染病人的临床资料。其中,30例行后腹腔镜输尿管上段切开取石术(腔镜组),26例行经皮肾镜碎石术(肾镜组),17例行输尿管软镜碎石术(软镜组)。术前均按细菌药敏结果抗感染治疗5~11 d。术前出现全身炎症反应(SIRS)的病人术前予行病侧输尿管逆行插管引流或肾造瘘引流等处理,待降钙素原/尿常规白细胞计数恢复正常或接近正常后行手术治疗。记录各组病例手术成功率、术后1个月结石取净率、术后降钙素原(PCT)值、术后抗生素使用天数等。结果腔镜组、肾镜组、软镜组三组一期手术成功率分别为100.00%、92.31%、94.12%,不同组一期手术成功率差异无统计学意义(P>0.05);三组1个月后结石取净率分别100.00%、88.46%、88.24%,不同组1个月后结石取净率差异无统计学意义(P>0.05);三组术后PCT值明显升高分别为6.67%、30.77%、35.29%,不同组术后PCT值明显升高百分比差异有统计学意义(P<0.05);三组术后抗生素使用天数分别为(2.20±0.76)d、(4.42±3.26)d和(4.76±3.61)d,不同组术后抗生素使用天数差异有统计学意义(P<0.05),肾镜组和软镜组术后抗生素使用天数均高于腔镜组(P<0.05)。结论后腹腔镜下输尿管切开取石术安全、有效,创伤小,恢复快,可作为治疗输尿管上段结石合并感染的推荐方案。

Objective To investigate the safety and efficacy of retroperitoneoseopic ureterolithotomy in the treatment of upper ure teral calculi with infection.Methods The clinical data of 73 patients with upper ureteral calculi complicated with infection in 910 Hospital of PLA Joint Logistics Support Force from September 2015 to September 2018 were retrospectively analyzed.Of these,30 underwent retroperitoneoseopic ureterolithotomy(group of RPUL),26 underwent percutaneous nephrolithotripsy(group of PCNL),and 17 underwent flexible ureteroscopy lithotripsy(group of FURL).Anti infective treatment was performed for 5 11 days according to bacterial susceptibility results before surgery.Patients with SIRS were treated with retrograde intubation drainage or renal fistula drainage before operation.The operation performed after the procalcitonin/urine white blood cell count returned to normal or ap proached normal.The success rate of surgery in each group,the rate of stone removal at 1 month postoperatively,postoperative pro calcitonin(PCT)value,postoperative antibiotic use days,etc.were recorded and analyzed.Results The success rates of the first stage operation of each group were 100.00%,92.31%and 94.12%,respectively.There was no statistically significant difference(P>0.05).The rate of stone removal 1 month after surgery was 100.00%,88.46%and 88.24%,respectively.There was no statistically sig nificant difference(P>0.05);The rate that PCT values was significantly increased postoperative was 6.67%,30.77%,and 35.29%,respectively.There was a statistically significant difference between the different groups(P<0.05).The days of antibiotics in the three groups were(2.20±0.76)days,(4.42±3.26)days,and(4.76±3.61)days,respectively.There was a statistically significant difference between the different groups(P<0.05).The days of antibiotics in group of PCNL and group of FURL were higher than those in group of RPUL,and the difference was statistically significant(P<0.05).Conclusion Retroperitoneal laparoscopic ure terolithotomy is safe and effective,with less trauma and quick recovery.It can be used as a recommended treatment for the treat ment of upper ureteral stones with infection.