上尿路结石合并尿脓毒血症的微创治疗

摘要

Objective To investigate the efficacy and safety of minimally invasive procedures in the treatment of upper urinary stones complicated with urosepsis . Methods A retrospective analysis was performed on 65 patients with upper urinary stones complicated with urosepsis in our center between May 2011 and February 2014.The first stage interventions included cystoscopic or percutaneous renal puncture catheter placement for drainage of urine and removal of obstruction .After the infection was controlled and stable general situations were obtained , a second stage operation of ureteroscopic or percutaneous nephroscopic lithotripsy was performed. Results Among first stage retrograde ureteral stenting , there were 53 cases of unilateral stones ( stenting succeed in 39 cases) and 12 cases of bilateral stones (stenting succeed bilaterally in 7 cases and unilaterally in 3 cases).B-ultrasound guided percutaneous nephrostomy was carried out in cases of failed stenting .Second stage treatment with flexible ureteroscopy or PCNL was performed after the patients became stable.The stone clearance rate was 93.8% (61/65).Combined with ESWL and traditional Chinese medicine treatment , there were only 2 cases of unilateral residual stones , the total stone clearance rate being 96.9%(63/65).After a mean follow-up of 6 months in the 65 cases, the renal functions were preserved or improved in all the cases .The uronephrosis disappeared in 55 cases and was recovered from severe to moderate degree in 7 cases.The remaining 3 cases of severe uronephrosis had no complications . Conclusion Our findings suggest that retrograde ureteral stenting represents a favorable option for patients with urosepsis and upper ureteral calculi .%目的：探讨上尿路结石合并尿脓毒血症微创手术治疗的疗效及安全性。方法2011年5月～2014年2月对65例上尿路结石合并尿脓毒血症积极抗感染的同时，一期在膀胱镜下或经皮肾穿刺置管，以引流尿液、解除梗阻，待患者感染控制、全身情况平稳后，二期行输尿管镜或经皮肾镜碎石术。结果一期膀胱镜下逆行插管，单侧结石53例，成功置入39例；双侧结石12例，双侧均成功置入导管7例，一侧成功置入导管3例。逆行插管失败者，在B超定位下行经皮肾穿刺置管。二期行腔内微创碎石手术，结石成功排出61例，结石清除率93．8％（61／65），再结合ESWL和中药排石等治疗方法，仅2例单侧结石残留，排石率96．9％（63／65）。65例术后6个月随访，肾功能及肾积水程度明显改善，其中55例肾积水消失，7例重度肾积水恢复至中度肾积水，3例重度积水，未出现严重并发症。结论膀胱镜下逆行或经皮肾穿刺顺行置管联合输尿管镜或经皮肾镜碎石术操作简便，耐受性好，安全性高，利于控制感染及恢复肾功能，两者联合可作为上尿路结石合并尿脓毒血症患者的理想治疗方式。