经皮肾造瘘肾盂减压治疗上尿路结石并尿源性脓毒血症的效果研讨

Study on the Effect of Percutaneous Nephrostomy and Renal Pelvis Decom⁃pression in the Treatment of Upper Urinary Tract Calculi Complicated with Urinary Sepsis

目的分析上尿路结石并尿源性脓毒血症患者运用经皮肾造瘘肾盂减压治疗的有效性。方法目的选取南京市第一医院于2023年2月—2024年2月收治的50例上尿路结石并尿源性脓毒血症患者为研究对象,根据治疗方式不同分为两组,各25例。参比组给予留置输尿管支架进行肾盂减压治疗,研究组运用经皮肾造瘘肾盂减压治疗。对比两组患者手术时间和二期碎石情况、实验室指标及并发症发生率。结果研究组的手术时间为(32.13±3.58)min,短于参比组的(38.66±3.84)min,差异有统计学意义(t=6.219,P<0.05);研究组的软镜使用率为0,低于参比组的24.00%(6/25),研究组结石清除率为96.00%(24/25),高于参比组的76.00%(19/25),差异有统计学意义(χ^(2)=6.818、4.153,P均<0.05)。研究组治疗后C反应蛋白、降钙素原、白细胞计数、血清内毒素水平低于参比组,差异有统计学意义(P均<0.05)。研究组并发症发生率低于参比组,但差异无统计学意义(P>0.05)。结论上尿路结石并尿源性脓毒血症患者运用经皮肾造瘘肾盂减压治疗效果较好,可以提高结石清除效率。

Objective To analyze the effectiveness of percutaneous nephrostomy and pelvic decompression in patients with upper urinary tract calculi and urinary sepsis.Methods Fifty cases of patients with upper urinary tract calculi and urosepsis admitted to Nanjing First Hospital from February 2023 to February 2024 were purposefully selected as the study subjects.According to different treatment methods,they were divided into two groups,twenty-five cases in each group.The reference group was treated with indwelling ureteral stent for renal pelvis decompression,and the study group was treated with percutaneous nephrostomy for renal pelvis decompression.The operation time and second-stage lithotripsy,laboratory indexes and incidence of complications were compared between the two groups.Results The operation time of the study group was(32.13±3.58)min,which was shorter than that of the reference group(38.66±3.84)min,the difference was statistically significant(t=6.219,P<0.05);the soft lens utilization rate of the study group was 0,which was lower than 24.00%(6/25)of the reference group,the stone clearance rate of the study group was 96.00%(24/25),which was higher than 76.00%(19/25)of the reference group,the differences were statistically significant(χ^(2)=6.818,4.153,both P<0.05).After treatment,the levels of C-reactive protein,procalcitonin,white blood cell count and serum endotoxin in the study group were lower than those in the reference group,and the differences were statistically significant(all P<0.05).The incidence of complications in the study group was lower than that in the reference group,but the difference was not statistically significant(P>0.05).Conclusion Percutaneous nephrostomy and renal pelvis decompression is effective in patients with upper urinary tract calculi and urinary sepsis,which can improve the efficiency of stone removal.