输尿管结石致尿源性脓毒血症行输尿管支架置入术后二期输尿管镜手术的时机分析

Analysis of the timing of secondary ureteroscopic surgery after ureteral stent placement in patients with urinary sepsis caused by ureteral calculi

目的评估输尿管结石导致的尿源性脓毒血症患者行输尿管支架置入术后二期输尿管镜的手术时机以及不同手术时间的安全性和有效性。方法回顾性分析本院2013年8月至2019年10月行输尿管支架置入术后二期输尿管镜手术的106例输尿管结石导致的尿源性脓毒血症患者的临床资料,其中52例在术后接受早期输尿管镜碎石术(URSL)(≤14 d)的患者被分为U组,54例接受延期URSL(>14 d)的患者被分为D组。比较两组患者的一般资料、结石大小、结石位置、术前留置双J管时间、手术时间、术后2周结石清除率和术后并发症发生率。结果U组的术前留置双J管时间短于D组,差异有统计学意义(P<0.001)。两组的手术时间、术后2周结石清除率、非感染性并发症及感染性并发症发生率比较,差异均无统计学意义(均P>0.05)。结论输尿管结石导致的尿源性脓毒血症患者行输尿管支架置入术后2周内行二期输尿管镜手术是安全、有效的,可以减少患者双J管的留置时间。

Objective To evaluate the timing,safety and effectiveness of the second-stage ureteroscopic lithotripsy after ureteral stent implantation in patients with urinary sepsis caused by ureteral calculi.Methods The clinical data of 106 patients with urinary sepsis caused by ureteral calculi who underwent second stage ureteroscopic lithotripsy after ureteral stent implantation in our hospital from August 2013 to October 2019 were analyzed retrospectively.Fifty-two patients who underwent early ureteroscopic lithotripsy(URSL)(≤14 days)after operation were divided into group U,and 54 patients who received delayed URSL(>14 days)were divided into group D.The general data,stone size,stone location,time of indwelling double-J tube before operation,operation time,stone clearance rate and postoperative complication rate of the two groups were compared.Results The time of indwelling double-J tube in group U was shorter than that in group D,the difference was statistically significant(P<0.001).There was no statistically significant difference between the two groups in operation time,stone clearance rate,non-infectious complications and infectious complications in two weeks after operation(all P>0.05).Conclusions It is safe and effective to perform secondary ureteroscopic surgery within two weeks after ureteral stent implantation in patients with urinary sepsis caused by ureteral calculi,which can reduce the indwelling time of double-J tubes.