目的 探讨上尿路结石并发感染性血小板减少症的治疗方法.方法 回顾性分析21例上尿路结石并发感染性血小板减少症患者的临床资料.21例血小板计数平均(49.4±36.5)×109/L.全组术前予抗炎治疗和应用糖皮质激素,12例予连续静脉滴注大剂量丙种球蛋白(HD-IVIG),8例子输注机器单采血小板1～2人份,1例未予HD-IVIG及输血小板,血小板均上升至80×109/L以上.10例随后行输尿管镜逆行插管术,7例行输尿管镜碎石置管术(URL),4例行微通道经皮肾造瘘术(MPCN).结果 19例通过上述处理肾功能好转,并作二期手术清除结石；1例在URL后出现严重血尿和肾周血肿；1例合并前列腺癌骨髓转移,术后因血小板进行性下降而死亡.结论 上尿路结石并发感染性血小板减少症的处理措施包括术前输注糖皮质激素、HD-IVIG或输注血小板提高血小板计数,使用输尿管镜逆行插管术、URL或MPCN作紧急引流.%[Objective] To investigate the management of upper urinary calculi complicated infective thrombo-cytopenia.[Methods] The clinical data of 21 patients of upper urinary calculi complicated infective thrombocytopenia were reviewed.The average of blood platelet counts (BPC) was (49.4±36.5) ×109/L.Anti-inflammatory agents and dexamethasone were prescripted in all cases.The BPC was above 80×109/L after high-dose intravenous immunoglobulin G (HD-IVIG) in 12 cases and platelet transfusion in 8 cases.Emergency drainage operations were performed,including retrograde catheterization under ureteroscopy in 10 cases,ureteroscopy lithotripsy (URL) in 7 cases,minimally-invasive percutaneous nephrostomy (MPCN) in 4 cases.[Results] The renal function improved and the second-staged calculi removal operation was performed in 19 cases.One complicated severe hematuria and perirenal hematoma postoperatively.One died from progressive thrombocytopenia.[Conclusions] For the cases of upper urinary calculi complicated infective thrombocytopenia,Glucocorticoids,HD-IVIG or platelet transfusion were applied preoperatively to elevate the BPC and emergency drainage operations URL or MPCN were selectively performed.
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