分期微通道经皮肾治疗合并尿脓毒症输尿管上段结石的临床分析

Clinical Analysis of Two Stages Microchannel Percutaneous Nephrolithotomy for the Treatment of the Upper Ureteral Calculi with Urosepsis

目的探讨采用分期微通道经皮肾手术治疗合并尿脓毒症输尿管上段结石的疗效。方法自2011年8月至2016年1月收治的24例合并尿脓毒症输尿管上段结石患者采用分期手术治疗,对其术后出现感染性休克,出血,结石残留等并发症进行分析。结果本组24例均完成Ⅰ期肾造瘘、Ⅱ期钬激光碎石。Ⅰ期肾造瘘术后15例不同程度发热,其中2例出现感染性休克,治疗后病情转平稳;Ⅱ期钬激光碎石一次碎石及清石,结石清除率为100%。术中无较严重出血,术后有2例出现发热,无感染性休克、输尿管撕脱、穿孔等并发症。结论采用分期微通道经皮肾手术治疗合并尿脓毒症输尿管上段结石,能有效解除梗阻,控制感染,且创伤小、安全可靠,可减少并发症的发生,具有较高临床价值。

Objective To evaluate the efficacy of two stages microchannel percutaneous nephrolithotomy for the treatment of the upper ureteral calculi combined with urosepsis. Methods Twenty-four cases with ureteral calculi urinary sepsis patients with two stages microchannel percutaneous nephrolithotomy were collected from August 2011 to January 2016,and the complications as septic shock,bleeding,residual stones were analyzed.Results Twenty-four patients underwent nephrostomy as stage one operation and holmium laser lithotripsy as stage two operation. Fifteen cases post stage one nephrostomy suffered from fever,including two cases of septic shock. However,the stone clearance rate of stage two laser lithotripsy was 100%,and only 2 patients had a temporary fever with no evidence of septic shock,ureteral mucosa avuls,and other complications. Conclusions Two stages microchannel percutaneous nephrolithotomy for the treatment the upper ureteral calculi with urosepsis is safe and reliable,which can reduce the incidence of complications.