输尿管支架管置入和经皮肾造瘘治疗上尿路结石梗阻合并尿脓毒血症的效果比较

Comparison of ureteral stent placement and percutaneous nephrostomy in the treatment of upper urinary tract calculi obstruction complicated with urinary sepsis

目的比较上尿路结石梗阻合并尿脓毒血症行输尿管支架管(DJS)置入和经皮肾造瘘(PCN)的疗效差异。方法回顾性分析2014年4月至2021年4月该院诊断为上尿路结石梗阻合并尿脓毒血症的患者,通过2种不同手术方式成功引流112例,74例采用输尿管镜直视下DJS置入(DJS组),38例在局部麻醉后行B超引导下PCN(PCN组)。收集患者人口学资料及临床数据、结石相关数据、术前及术后实验室数据等。结果2种手术方式安全有效。PCN组患者术后平均血小板计数为329×10^(9)/L,高于DJS组的234.5×10^(9)/L;PCN组患者术后血清降钙素原(PCT)为0.67 mg/L,低于DJS组的1.36 mg/L;PCN组患者术后转重症监护室(ICU)比例为5.26%,低于DJS组的21.62%;PCN组患者中位总住院时间为11 d,高于DJS组的7 d;PCN组患者中位术后住院时间为6 d,高于DJS组的5 d,差异均有统计学意义(P<0.05)。结论急诊处理上尿路结石梗阻合并尿脓毒血症时,PCN和DJS均为有效的引流方法,但PCN的术后引流效果较DJS更佳。

Objective To compare the curative effect of ureteric stent placement(DJS)and percutaneous nephrostomy(PCN)for patients with obstructive upper urinary tract calculi complicated with urinary sepsis.Methods The patients with upper urinary tract calculi obstruction complicated with urinary sepsis diagnosed in this hospital from April 2014 to April 2021 were analyzed retrospectively.A total of 112 cases were successfully drained by two different surgical methods,74 cases were treated with DJS implantation under ureteroscope(DJS group),38 cases were treated with PCN under the guidance of B-ultrasound after local anesthesia(PCN group).The demographical characteristics,clinical data,calculi related data,and preoperative and postoperative laboratory data and so on were collected.Results Both DJS and PCN were effective.Compared with the DJS group,the postoperative platelet was higher(329×10^(9)/L vs.234.5×10^(9)/L);the procalcitonin was lower(0.67 mg/L vs.1.36 mg/L);the postoperative ICU admission was lower(5.26%vs.21.62%);the overall length of hospital stays(11 days vs.7 days);and post procedure hospitalization was higher(6 days vs.5 days),the differences were statistically significant(P<0.05).Conclusion PCN and DJS are both effective drainage methods for obstructive upper urinary tract calculi complicated with urinary sepsis in emergency treatment.However,the postoperative drainage effect of PCN is better than that of DJS.