内外引流肾盂减压治疗急诊输尿管结石梗阻性尿脓毒血症的效果比较

Effect comparison of internal and external drainage of renal pelvis decompression in the treatment of emergency ureteral calculi obstruction complicated with urinary sepsis

目的比较经皮肾穿刺造瘘手术(PCN)外引流肾盂减压与经尿道输尿管内支架管置入手术(US)内引流肾盂减压治疗急诊输尿管结石梗阻性尿脓毒血症的效果。方法选取2018年3月至2021年3月高州市人民医院收治的102例急诊输尿管结石梗阻合并尿脓毒血症患者作为研究对象,采用简单随机化法分为外引流组(52例)与内引流组(50例)。外引流组采用PCN术,内引流组采用US术。比较两组患者的肾盂减压成功率、感染控制情况、手术并发症、术后生活质量。结果两组患者的肾盂减压成功率、体温恢复正常时间、血白细胞计数(WBC)恢复正常时间、C反应蛋白恢复正常时间、降钙素原(PCT)恢复正常时间、术后住院天数比较,差异无统计学意义(P>0.05)。两组患者的肾盂输尿管支架穿孔、肾出血发生率比较,差异无统计学意义(P>0.05)。内引流组的术后腰痛、睡眠障碍发生率低于外引流组,差异有统计学意义(P<0.05)。内引流组的术后2 h感染进展率高于外引流组,差异有统计学意义(P<0.05)。结论两种肾盂减压方式均能有效控制输尿管结石梗阻性尿脓毒血症,但PCN术的安全性优于US术,US术后的舒适度及生活质量优于PCN术。因此,在治疗方面需考虑患者的情况及医生的技术等因素,选择合适的肾盂减压方式。

Objective To compare the effect of percutaneous nephrostomy(PCN)external drainage and transurethral ureteral stenting(US)internal drainage in the treatment of emergency ureteral calculi obstructive urinary sepsis.Methods A total of 102 patients with emergency ureteral calculi obstruction complicated with urinary sepsis in Gaozhou People′s Hospital from March 2018 to March 2021 were selected as the research objects,and the patients were divided into the external drainage group(52 cases)and the internal drainage group(50 cases)according to the simple randomization method.The external drainage group was treated with PCN,and the internal drainage group was treated with US.The success rate of renal pelvis decompression,infection control,surgical complications and postoperative quality of life were compared between the two groups.Results There were no significant differences between the two groups in the success rate of renal pelvis decompression,the time of body temperature returning to normal,the time of white blood cell(WBC)returning to normal,the time of C-reactive protein returning to normal,the time of procalcitonin(PCT)returning to normal and the days of postoperative hospitalization(P>0.05).There were no significant differences in the incidence of ureteropelvic stent perforation and renal hemorrhage between the two groups(P>0.05).The incidence of postoperative back pain and sleep idsorders of the internal drainage group was lower than that in the external drainage group,and the difference was statistically significant(P<0.05).The infection progression rate at 2 h after operation in the internal drainage group was higher than that in the external drainage group,the difference was statistically significant(P<0.05).Conclusion Both methods of renal pelvis decompression can effectively control ureteral calculi obstruction complicated with urinary sepsis,but the safety of PCN is better than that of US,and the comfort and quality of life after US are better than those after PCN.Therefore,in terms of treatment,it is necessary to consider the situation of patients and the technology of doctors,and choose the appropriate way of renal pelvis decompression.