双J管留置时间对糖尿病合并感染性输尿管结石患者疗效的影响分析

Analysis of the effect of double J stent indwellin time on the efficacy in diabetic patients with infections ureteral calculi

目的 探讨糖尿病合并感染性输尿管结石患者的感染病原菌种类及其耐药性,分析术前留置双J管的时长对治疗效果和术后并发症的影响。方法 回顾性分析2019年1月—2021年2月南京医科大学第四附属医院收治的167糖尿病合并感染性输尿管结石患者临床资料。所有患者均在留置双J管后消除明显感染症状,然后行经皮肾镜取石术或输尿管镜钬激光碎石术。根据双J管留置时间将患者分为对照组(≤7 d)和研究组(>7d),分别为74例和93例。比较两组患者的一般资料、血常规和尿常规检查结果、无石率和术后并发症发生情况,并对所有患者的感染病原菌进行鉴定和药敏试验。结果 本次研究共检出71株感染病原菌,以革兰阴性菌为主(63.38%),其中大肠杆菌、铜绿假单胞菌和金黄色葡萄球菌为最常见的3种。两组患者在一般资料、手术方式、手术时间和平均住院时间方面无统计学差异(P>0.05)。两组患者在留置双J管前和留置双J管后第7天时的尿白细胞水平和血白细胞水平差异无统计学意义,但两组均在留置7 d后较留置前明显降低(P<0.05)。两组患者的术后1个月内无石率相似(P>0.05)。在术后并发症方面,两组患者在暂时性低热、发热、血尿、输尿管穿孔等方面无显著差异,但是尿路刺激征和尿路感染在研究组中明显高于对照组(P<0.05)。结论 术前留置双J管的时长对糖尿病合并感染性输尿管结石患者的治愈率无显著影响,但是较长的双J管留置时间会增加患者术后出现尿路刺激征和尿路感染的风险。

Objective To study the types of pathogenic bacteria and their drug resistance in diabeticpatients with infections ureteral calculi,and to analyze the impact of preoperative double J stent duration on treatment and postoperative complications.Methods A retrospective analysis was conducted on 167 diabetic patients with acute upper urinary tract infections of ureteral stones admitted to The Fourth Affiliated Hospital of Nanjing Medical University from January 2019 to February 2021.All patients had double J tubes performed and underwent percutaneous nephrolithotomy or ureteroscopic holmium laser lithotripsy.Patients were divided into control group(≤7 days,n=74)and study group(>7 days,n=93)according to double J stent duration.Clinical data,blood cell counts,urinalysis results,stone-free rate and postoperative complications were compared between the two groups.Pathogenic bacteria were identified and drug sensitivity were tested for all patients.Results A total of 71 species of bacteria were detected in this study,mainly Gram-negative bacteria(63.38%),of which Escherichia coli,Pseudomonas aeruginosa and Staphylococcus aureus were the three most common.There was no statistical difference in clinical data,surgical procedure,duration of surgery and hospitalzation time between the two groups(P>0.05).There was no significant difference in urine leukocyte levels and blood leukocyte levels between the two groupsbefore and at 7 days;however,however,compared with before indwelling,both groups decreased significantly(P<0.05).The stone-free rate in the postoperative month was similar as both groups(P>0.05).There was no significant difference in postoperative complications,temporary hypothermia,fever,haematuria,and ureteral perforation between the two group.The urinary tract irritation sign and urinary tract infection of the study group were significantly higher than those of the control group(P<0.05).Conclusion Prolonged preoperative double J stent duration does not significantly impact cure rate in diabetic patients with acute infections ureteral calculi,but increases the risk of postoperative irritation symptoms and urinary tract infections.