微创手术为中心的多学科协作模式治疗尿脓毒症

Multidisciplinary diagnosis and treatment mode centered on minimally invasive surgery for urosepsis

目的研究以微创手术引流方式为中心的多学科协作模式治疗(MDT)对尿毒脓毒症的有效性。方法选取2017年3月至2019年6月期间本院诊断为上尿路结石梗阻合并感染导致尿脓毒症需要手术的50例患者。手术方式:①经皮肾盂造瘘引流(必要时1期碎石);②逆行置D-J管(必要时1期碎石);③如果逆行置D-J受阻,则改为肾盂造瘘引流术。统计患者的救治成功率并采用二项分布函数法进行分析。结果20例患者行肾盂造瘘术;12例行肾盂造瘘术并1期碎石并置D-J管;4例输尿管镜下碎石术并置D-J管;14例患者行逆行置D-J管术。共16例患者1期碎石术。2例输尿管上段结石患者逆行置D-_J管,梗阻解除效果较差。3例脓毒性休克的患者休克未完全纠正。尿脓毒症救治成功率97.06%(33/34)及脓毒性休克患者救治成功率81.25%(13/16),与目前文献(尿脓毒症救治成功率20%、脓毒性休克患者救治成功率40%)比较,差异均有统计学意义(P<0.05)。结论①以微创手术为核心的MDT在上尿路梗阻的尿脓毒症救治有重要意义;②上尿路梗阻合并脓毒症,引流去除感染源是其重要治疗手段之一,其中同时行肾盂造瘘加输尿管D-J管支架疗效最佳。

Objective To study the effectiveness of multidisciplinary diagnosis and treatment(MDT)treatment mode centered on minimally invasive surgical drainage in patients with upper urinary tract infection with urinary sepsis.Methods Patients who underwent surgery for upper urinary tract calculi obstruction and infection leading to urinary sepsis were analyzed during March 2017 and June 2019.Inclusion criteria:renal pelvis,ureteral calculi,stones with obstruction,sequential organ fail-ure score(SOFA)>2 points,or fast SOFA(qSOFA)>2 points.There were 50 patients,aged 30-73 years.There were 24 male patients and 36 female patients.After admission,patients were admitted to the ICU ward.After initial treatment,MDT with consultation,if there was surgical indication,we de-veloped anesthesia plan.The minimally invasive surgery drainage was performed within 6 hours.Surgi-cal methods:①Percutaneous nephrostomy sputum drainage.②Ureteral stones<1 cm retrograde D-J tube.③If the retrograde D-J blocked,it was quickly changed to renal pelvis fistula drainage.The suc-cess rate of treatment was compared with the current guidelines by the binomial distribution function method.,and SPSS 19.0 statistical software was used.Results Twenty patients underwent nephrostomy,and 12 patients underwent nephrostomy with stage 1 lithotripsy and D-J tube.Four patients under-went ureteroscopic lithotripsy and D-J tube.Fourteen patients underwent retrograde D-J tube.Two pa-tients with ureteral calculi were retrogradely placed in the D-J tube,and the effect of obstruction was not good.In 3 patients with septic shock,shock was not completely corrected.The success rate of MDT treatment mode with minimally invasive surgery as the core was higher than the success rate of current literature treatment,which was stistically significant(P<0.05).Conclusions MDT mode with minimally invasive surgery as the core is of great significance in the treatment of urinary sepsis with upper urinary tract obstruction.Upper urinary tract obstruction combined with sepsis,drainage to remove the source of infection is one of the important treatments,at the same time,the most effective treatment is renal fistula plus ureteral D-J tube stent.The rapid and effective treatment of crushed stones do not find an increase in the adverse consequences of sepsis.