不同引流方式在临床治疗输尿管结石梗阻致尿脓毒症中的疗效研究

doi:10.19558/j.cnki.10-1020/r.2018.05.009

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摘要目的探讨不同引流方式在临床治疗输尿管结石梗阻致尿脓毒症中的疗效。方法选取2013年3月~2017年3月期间收治的输尿管结石梗阻致尿脓毒症患者70例,按照病情等级不同分为轻微组、重度组和休克组,结合病情等级和临床状况,重度组、休克组患者给予逆行留置双J管治疗,轻微组和逆行留置双J管不成功的患者给予经皮肾造瘘引流或气压弹道碎石术后留置双J管引流治疗,其中给予中度积水患者经皮肾造瘘引流,给予轻度积水患者气压弹道碎石术后留置双J管引流治疗。比较三组患者临床疗效、不良发生率的差异。结果采取逆行留置双J管引流患者29例,经皮肾造瘘引流患者19例,气压弹道碎石术后留置双J管引流患者22例,均减压成功;轻微组术后恢复时间(3.54±1.46)d,重度组术后恢复时间(6.27±1.83)d,休克组术后恢复时间(15.12±2.54)d,三组比较差异有统计学意义(P<0.05);轻微组VAS评分(3.81±1.36)分,重度组VAS评分(4.32±1.23)分,休克组VAS评分(5.14±1.15)分,三组比较,差异有统计学意义(P<0.05);三组结石清除率分别为93.14%、87.21%、83.06%,差异无统计学意义(P>0.05);三组不良发生率分别为5.6%、11.2%、12.5%,差异无统计学意义(P>0.05);三组患者在治疗前WBC水平和PLT水平对比,差异有统计学意义(P<0.05);而在治疗后,三组患者间以上两项指标对比,均差异无统计学意义(P>0.05)。三组患者WBC水平和PLT水平组内治疗后与治疗前对比,均差异有统计学意义(P<0.05)。结论在临床治疗输尿管结石梗阻致尿脓毒症时,通过结合患者的脓毒症病情和肾积水等临床情况,制定针对性的治疗方案积极治疗,可以有效改善患者病症,且不良反应较少,值得在临床进行广泛推广。

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关键词 ：输尿管结石梗阻, 尿脓毒症, 双J管, 经皮肾造瘘, 气压弹道碎石术

Abstract：Objective:To explore the efficacy of different drainage methods in the treatment of urethral sepsis caused by ureteral calculi obstruction. Methods:Seventy patients with urethral septicemia caused by ureteral calculi obstruction in our hospital from March 2013 to March 2017 were selected. In accordance with the different levels of illness, the patients were divided into mild group, severe group and shock group. In combination with the severity of the disease and clinical conditions, severe group and shock group were given retrograde double J tube treatment. The patients in the mild group and those failed to retrograde indwelling double-J tube were given percutaneous nephrostomy drainage or double J tube drainage following pneumatic lithotripsy. The patients with moderate hydronephrosis were given percutaneous nephrostomy drainage, and those with mild hydrocephalus were given double J tube drainage treatment following pneumatic lithotripsy. The clinical efficacy and the incidence of adverse reactions were compared among the three groups. Results:Twenty-nine patients were subjected to retrograde placement of double J tube drainage, 19 cases to percutaneous nephrostomy drainage, and 22 cases to double J tube drainage following pneumatic lithotripsy. All patients were decompressed successfully. The recovery time in mild, severe and shock groups was (3.54±1.46), (6.27±1.83), and (15.12±2.54) days respectively with the difference being statistically significant among the three groups (P<0.05). VAS score in mild, severe and shock groups was (3.81±1.36), (4.32±1.23) and (5.14±115) respectively with the difference being statistically significant among the three groups (P<0.05). The stone clearance rates in mild, severe and shock groups 93.14%, 87.21% and 83.06% respectively, with no significant difference (P>0.05). The incidence of adverse reactions in mild, severe and shock groups was 5.6%, 11.2% and 12.5% respectively, with no significant difference (P>0.05). There were significant differences in WBC counts and PLT levels among the three groups before treatment (P<0.05). After treatment, there was no significant difference in the above two indexes among the three groups (P>0.05). There was significant difference in WBC counts and PLT levels in three groups before and after treatment (P<0.05). Conclusions:In the clinical treatment of ureteral obstruction-induced urinary sepsis, based on the clinical conditions of sepsis and hydronephrosis, the development of targeted treatment can effectively improve the patient's conditions, and redcue adverse reactions. It is worth to be widely promoted clinically.

Key words： ureteral calculi obstruction urinary sepsis double J tube percutaneous nephrostomy pneumatic lithotripsy

收稿日期: 2017-11-09

ZTFLH:

R693.4

通讯作者: 陈建军,davidlingli@163.com

引用本文:

陈建军, 陆东权, 李强, 魏雪峰. 不同引流方式在临床治疗输尿管结石梗阻致尿脓毒症中的疗效研究[J]. 微创泌尿外科杂志, 2018, 7(5): 322-326.
Chen Jianjun, Lu Dongquan, Li Qiang, Wei Xuefeng. Efficacy of different drainage methods in the treatment of urinary sepsis by ureteral calculi obstruction. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(5): 322-326.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1446.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2018/V7/I5/322

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