[1]蒋祥新,关胜,蔡万松等.不同引流术急诊处理输尿管结石梗阻合并尿脓毒血症的比较[J].中国微创外科杂志,2012,12(6):534-536.
　Jiang Xiangxin,Guan Sheng,Cai Wansong,et al.Comparison of Two Drainage Approaches for Emergency Treatment of Ureteral Calculus Obstruction Complicated with Urinary Sepsis[J].Chinese Journal of Minimally Invasive Surgery,2012,12(6):534-536.
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不同引流术急诊处理输尿管结石梗阻合并尿脓毒血症的比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
12
期数:
2012年6期
页码:
534-536
栏目:
出版日期:
2012-06-15

文章信息/Info

Title:
Comparison of Two Drainage Approaches for Emergency Treatment of Ureteral Calculus Obstruction Complicated with Urinary Sepsis
作者:
蒋祥新; 关胜; 蔡万松等
浙江省富阳市人民医院泌尿外科，富阳311400
Author(s):
Jiang Xiangxin;  Guan Sheng;  Cai Wansong;  et al.
Deparment of Urology, Fuyang Municipal Hospital, Fuyang 311400, China
关键词:
输尿管结石; 尿脓毒血症; 输尿管镜; 经皮肾穿刺造瘘术
Keywords:
Ureteral calculi; Urinary sepsis; Ureteroscopy; Percutaneous nephrostomy
分类号:
R693+.4
文献标志码:
A
摘要:
目的比较2种不同引流术急诊处理输尿管结石梗阻合并脓毒血症的有效性及安全性。方法2003年3月～2011年3月52例输尿管结石梗阻合并尿脓毒血症，27例采用输尿管镜直视下逆行置入双J管引流术（输尿管镜组），25例采用B超引导下经皮肾穿刺造瘘术治疗（经皮肾组）。结果输尿管镜组由6名不同级别术者完成，经皮肾组由2名高级别术者完成。输尿管镜组置管引流成功率（100%）明显高于经皮肾组（21/25，84.0%）（Fisher’s检验，P=0.047）；2组术后尿脓毒血症控制时间无统计学差异［（6.5±1.2）d vs.(6.4±1.2)d,t=0.300，P=0.765］；2组无输尿管穿孔、大出血及死亡等严重并发症。结论输尿管镜直视下逆行置入双J管引流术和经皮肾穿刺造瘘术均为急诊处理输尿管结石梗阻合并尿脓毒血症安全有效的方法；输尿管镜直视下逆行置入双J管引流术置管成功率更高；对于超声技术不熟练的术者和患肾轻度积水的患者，推荐首选输尿管镜手术。
Abstract:
ObjectiveTo compare the safety and efficacy of drainage via two different approaches for emergency treatment of ureteral calculus obstruction complicated with urinary sepsis.MethodsFrom March 2003 to March 2011, 52 patients with ureteral calculus obstruction complicated with urinary sepsis, were admitted to our hospital. Among the patients, 27 patients underwent the drainage by inserting a double J tube under a retrograde ureteroscope (ureteroscopy group), the other 25 patients received percutaneous nephrostomy (percutaneous group).ResultsIn the ureteroscopy group, the procedure was completed by six surgeons at different levels, whereas, in the percutaneous group, all the procedure was carried out by two senior doctors. The success rate of drainage in the ureteroscopy group was significantly higher than that in the percutaneous group ［100% vs. 84.0% (21/25), Fisher’s test: P=0047］. No significant difference was found in the time of controlling sepsis after the operation ［(6.5±1.2) d vs. (6.4±1.2) d, t=0.300, P=0.765］. Neither the group had ureteral perforation, massive bleeding or death. ConclusionsBoth percutaneous nephrostomy and doubleJ tube insertion by retrograde ureteroscopy are effective emergency treatments for patients with ureteral calculus obstruction complicated with urinary sepsis. However, we recommend the latter as the first choice, especially for unskilled surgeons and patients with mild hydronephrosis, as its success rate is higher.

参考文献/References:

[1]Amano T, Matsui F, akashima H, et al. Analysis of patients with septic shock due to urosepsis brought on by ureteral calculi. Hinyokika Kiyo,2003,49(1):1-4.
[2]那颜群，叶章群，孙光，主编．中国泌尿外科疾病诊断治疗指南．北京：人民卫生出版社，2011．296-298．
[3]孙颖浩．泌尿系结石微创治疗的若干问题．中国微创外科杂志，2011，11（1）：6-8．
[4]林云华，姜永光，王俊生，等．输尿管结石继发严重上尿路感染的联合治疗．临床泌尿外科杂志，2009，24（7）：520-521．
[5]庄乾元，主编．经尿道手术学．武汉：湖北科学技术出版社，2002．34-35．
[6]马鸿钧，李天维，周成刚．输尿管镜诊疗术后的感染防范．中国内镜杂志，2004，4：31-32．
[7]应向荣，徐国强．输尿管镜下超声弹道碎石术联合应用负压吸引装置治疗急性梗阻性肾功能衰竭．现代中西医结合杂志，2008，17(2)：238-260．
[8]Johnson DB, Pearle MS. Complications of uretemscopy. Urol Clin North Am,2004,31(1):157-171.
[9]杨雄，侯腾，韩晓敏，等．35例上尿路梗阻性无尿患者的急诊处理及临床分析．临床泌尿外科杂志，2010，25（12）：890-891．

更新日期/Last Update: 2012-06-15