微通道经皮肾镜碎石术治疗感染性结石合并尿液CRPA感染两例

Application of mPCNL for Two Cases of Infectious Stones Combined with Urinary CRPA Infection

目的:总结一期行微通道经皮肾镜碎石术(microchannel percutaneous nephrolithotripsy,m PCNL)治疗上尿路感染性结石合并尿培养为耐碳青霉烯铜绿假单胞菌(carbapenem resistant pseudomonas aeruginosa,CRPA)的经验。方法:选择我院收治两例左肾结石合并尿培养为CRPA的患者,经积极抗感染治疗后,病例一行左侧经皮肾镜碎石术,病例二先行右肾穿刺造瘘术成功后行左侧经皮肾镜碎石术,观察分析两例患者术后结石清除情况,术中术后出现发热、腰痛、大出血、尿路损伤及肾功能衰竭等并发症情况。结果:两例患者术后复查双J管位置良好,结石基本清除;术中、术后均未出现发热、腰痛、大出血、尿路损伤及肾功能衰竭等并发症。结论:经过合适的围手术期处理,一期微通道经皮肾镜碎石术治疗感染性结石合并尿培养为耐药菌的患者是安全可行的。

Objective: To summary the first phase of m PCNL in the treatment of upper urinary tract infectious stones combined with urinary culture to carbapenem resistant pseudomonas aeruginosa(CRPA) experience. Methods: Two patients with left kidney stones combined with urine culture of CRPA were selected in our hospital. After active anti-infective treatment, the patient underwent left percutaneous nephrolithotomy. In case two, the right renal puncture fistula was performed successfully and the left Percutaneous nephrolithotomy. The postoperative stone removal, complications such as fever, low back pain, major bleeding, urinary tract injury and renal failure occurred during and after surgery were obderved. Results: Two patients underwent re-examination of the double-J tube in good position and basically cleared stones;no complication such as fever, low back pain, major bleeding, urinary tract injury, and renal failure occurred during and after the operation was observed. Conclusion: After appropriate perioperative treatment, a single-stage microchannel percutaneous nephrolithotomy is safe and feasible for patients with infectious stones and urine cultured as drug-resistant bacteria.