不同引流方式在结石所致尿源性脓毒症中的救治价值

Value of Different Drainage Methods in the Treatment of Urogenic Sepsis Caused by Calculi

目的:探讨不同引流方式在结石所致尿源性脓毒症中的救治价值。方法:随机纳入本院2016年1月-2020年6月收治的结石所致尿源性脓毒症患者61例。根据治疗方法分为三组,实行输尿管镜逆行留置双J管引流的患者纳入输尿管镜组(n=25),采用B超引导下经皮肾穿刺造瘘术引流的患者纳入经皮肾造瘘组(n=21),先行输尿管置管术失败后立即改为输尿管切开取石的患者纳入输尿管切开取石组(n=15)。对比三组救治效果。结果:治疗后3 d,三组梗阻解除成功率分别为92.00%、95.24%和100%,差异无统计学意义(P>0.05),三组体温下降至正常时间、住院时间比较差异无统计学意义(P>0.05), 治疗后3 d,输尿管镜组CRP、PCT、WBC水平高于经皮肾造瘘组和输尿管切开取石组,差异有统计学意义(P<0.05),经皮肾造瘘组和输尿管切开取石组CRP、PCT、WBC水平比较差异无统计学意义(P>0.05)。结论:输尿管镜双J管引流和肾造瘘引流均能有效改善尿道梗阻症状,但肾造瘘引流和输尿管切开取石引流更适于尿源性脓毒症的临床救治。

Objective:To investigate the therapeutic value of different drainage methods in treating urogenic sepsis caused by calculi.Method:Fifty-one patients with urogenic sepsis caused by calculi admitted to our hospital from January 2016 to June 2020 were randomly included.According to treatment they were divided into three groups,patients who received retrograde indwelling double J tube drainage under ureteroscopy were included in the ureteroscopy group(n=25),patients who received B-ultrasound-guided percutaneous nephrostomy for drainage were included in the percutaneous nephrostomy group(n=21),patients who immediately switched to ureterolithotomy after failure of ureteral catheterization were included in the ureterolithotomy group(n=15).The treatment effect of the three groups was compared.Result:After 3 d of treatment,the success rates of obstruction relief in the three groups were 92.00%,95.24%and 100%,respectively,with no statistically significant difference(P>0.05).There were no significant differences in the temperature dropped to normal time,length of stay among the three groups(P>0.05).At 3 d after treatment,the levels of CRP,PCT and WBC in the ureteroscopy group were higher than those in the percutaneous nephrostomy group and the ureterolithotomy group,and the differences were statistically significant(P<0.05),there were no significant differences in CRP,PCT and WBC levels between the percutaneous nephrostomy group and the ureterolithotomy group(P>0.05).Conclusion:Ureteroscopic double J tube drainage and nephrostomy drainage can effectively improve the symptoms of urethral obstruction,but renal fistula drainage and ureterotomy drainage are more suitable for the clinical treatment of urogenic sepsis.