旁置输尿管导管输尿管镜激光碎石术在初期结石梗阻性尿脓毒症治疗中的应用效果

Effect of ureteroscopic laser lithotripsy with catheter placed beside the ureteroscope in the treatment of early stage stone obstructive urinary sepsis

目的:探讨旁置输尿管导管输尿管镜激光碎石术在初期结石梗阻性尿脓毒症治疗中的应用效果。方法:选取2019年6月-2022年6月山东第一医科大学第二附属医院泌尿外科收治的65例初期结石梗阻性尿脓毒症患者,根据引流方式不同分为A组(n=31)和B组(n=34)。A组给予旁置输尿管导管输尿管镜激光碎石术并留置双J管,B组给予单纯留置双J管,对比两组治疗效果。结果:治疗后,A组体温、白细胞、降钙素原恢复正常时间均好于B组,差异均有统计学意义(P<0.05)。A组术后X线片均显示双J管位置良好,B组出现两例双J管穿出输尿管壁至腹膜后腔;A组有11例患者因结石被初步击碎后未能排出行二期手术治疗;B组34例患者均行二期手术治疗。结论:相较于单纯留置双J管治疗,旁置输尿管导管输尿管镜激光碎石术在因输尿管结石梗阻造成的初期尿脓毒症治疗中的应用效果更好,且安全性较高。

Objective To compare and analyze the therapeutic effect of ureteroscopic laser lithotripsy with catheter placed beside the ureteroscope and double J ureteral stent indwelling in the treatment of early urinary sepsis caused by stone obstruction.Methods A total of 65 patients with early urinary sepsis caused by stone obstruction admitted to the Department of Urology,Second Affiliated Hospital of Shandong First Medical University from June 2019 to June 2022 were divided into group A(n=31)and group B(n=34)according to different drainage methods.Group A was given para-ureteral catheter ureteroscopic laser lithotripsy with indwelling double J tubes,and group B was given simple indwelling double J tubes,comparing the treatment effects of the two groups.Results After treatment,the recovery time of body temperature,white blood cell count and procalcitonin in group A were better than those in the group B(P<0.05).Postoperative radiographs in group A showed that the double J tubes were in good position,while in group B,two cases of double J tubes penetrated the ureteral wall to the retroperitoneal cavity;In group A,11 patients failed to discharge the stone after it was initially broken and underwent secondary surgery;Group B:34 patients were treated with second-stage surgery.Conclusion Compared with the simple indwelling double-J tube treatment,the application of ureteroscopic laser lithotripsy with side-placed ureteral catheter in the treatment of early urinary sepsis caused by ureteral stone obstruction is more effective and safe.