Ureteral catheterization combined with flexible ureteroscopeholmium laserlithotripsy in the treatment of upper urinary calculi complicated with urine-derived sepsis: a report of 35 cases
YIN Yonghua1, WEN Bo1, XIA An1, YOU Hongke1
1Department of Urology,Shenzhen Hospital of Integrated Traditional and West Medicine, Guangzhou Medical University, Shenzhen 518104, China
Abstract：Objective： To investigate the curative effect and the safety of ureteral stent implantation combined with flexible ureteroscopic holmium laser lithotripsy for upper urinary calculi with urinary sepsis. Method： Between July 2016 to July 2018, a total of 35 patients with acute obstruction of upper urinary calculi with urinary sepsis in our department were retrospectively analyzed. Result： The ureteral stents were successfully placed into the renal pelvis in 35 patients. The average operation time was (8.5±3.47) min. The overall infections were treated with anti-infection after the operation. The postoperative 24 h pain score and the average postoperative hospital stay were (2.35±1.26) and (6.64±3.52) days, respectively. All patients were re-admitted to flexible ureteroscopic holmium laser lithotripsy after 2-4 weeks. The operation time was (51.75±8.18) min. The hospitalization time was (2.38±1.66) days. The postoperative 24 h pain score was (2.17±1.05). At 1st day after surgery, the CT re-examinations showed that the average stone clearance rate was 91.43%. And we used the extracorporeal shock wave lithotripsy to treat the patients left. The CT re-examination within 1 month after surgery showed no residual stone, and the double J tube was removed. Conclusion： Our findings indicate that ureteral stent implantation combined with flexible ureteroscopic holmium laser lithotripsy for upper urinary calculi with urinary sepsis is safe and reliable, being worthy of application.
尹永华, 文博, 夏安, 尤洪科. 输尿管置管联合输尿管软镜钬激光碎石治疗上尿路结石合并尿脓毒 血症（附35例报告）[J]. 微创泌尿外科杂志, 2020, 9(3): 186-190.
YIN Yonghua, WEN Bo, XIA An, YOU Hongke. Ureteral catheterization combined with flexible ureteroscopeholmium laserlithotripsy in the treatment of upper urinary calculi complicated with urine-derived sepsis: a report of 35 cases. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(3): 186-190.
[1] TURK C.Urolithiasis guidelines: retrospective view and perspectives. Urologe A, 2016,55(10):1317-1320. [2] WAGENLEHNER FM, PILATZ A, NABER KG, et al.Therapeutic challenges of urosepsis. Eur J Clin Invest, 2008,38(S2):45-49. [3] 那彦群,叶章群,孙颖浩.2014版中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2014:129-166. [4] 李化升,杨传,陈丽芬.结石相关性尿源性脓毒血症的研究进展.中国内镜杂志,2015,21(4):381-385. [5] TURK C, PETRIK A, SARICA K, et al.EAU guidelines on interventional treatment for urolithiasis. Eur Urol, 2016,69(3):475-482. [6] 刘百川,张福霖,钟瑞伦,等.MPCNL与FURL治疗肾实质厚度>2.5cm的2~3cm肾结石的疗效对比.临床泌尿外科杂志,2018,33(07):537-541. [7] 李鑫,何云锋,吴小候,等.上尿路结石腔道手术后并发尿脓毒血症的危险因素分析.重庆医科大学学报,2018,43(04):590-594. [8] DELA ROSETTE J, ELHILALI M, NAITO S, et al.Clinical research office of the endourological society global GreenLight laser study:outcomes from a contemporary series of 713 patients. Int J Urol, 2015,22(12):1124-1130. [9] 黄洁夫,湛海伦,刘小彭,等.尿源性脓毒血症的防治.中华临床医师杂志(电子版),2012,6(7):1897-1899. [10] ZHONG W, LETO G, WANG L, et al.Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol, 2015,29(1):25-28. [11] KUMAR S, BAG S, GANESAMONI R, et al.Risk factors for urosepsis following percutaneous nephrolithotomy: role of 1 week of nitrofurantoin in reducing the risk of urosepsis. Urol Res, 2012,40(1):79-86. [12] MARIAPPAN P, TOLLEY DA.Endoscopic stone surgery: minimizing the risk of post-operative sepsis. Curr Opin Urol, 2005,15(2):101-105. [13] GUTIERREZ J, SMITH A, GEAVLETE P, et al.Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol, 2013,31(5):1135-1140. [14] LAIRD AM, MILLER PR, KILGO PD, et al.Relationship of early hyperglycemia to mortality in trauma patients. J Trauma, 2004,56(5):1058-1062. [15] 玉苏甫·艾比布力,哈木拉提·吐送,王峰,等.输尿管软镜碎石术并发尿源性脓毒血症的危险因素分析.中华腔镜泌尿外科杂志(电子版),2017,11(1):49-53. [16] 钟文,赖贺,赵志健,等.输尿管软镜钬激光碎石术后全身炎症反应综合征的风险因素评估.临床泌尿外科杂志,2016,31(3):243-246. [17] 程跃,刘冠琳.输尿管软镜治疗上尿路结石的现状与进展.现代泌尿外科杂志,2014,19(05):285-288. [18] 杜跃林,张宗平,李云祥,等.上尿路结石微创术后尿源性脓毒血症的危险因素研究进展.西部医学,2018,30(02):299-302. [19] 梁荣杰,陈增谋,胡春勇,等.输尿管软镜碎石术后尿源性脓毒血症发生的相关危险因素分析.现代医学,2017,45(10):1413-1416. [20] LEVY MM, ARTIGAS A, PHILLIPS GS, et al.Outcomes of the surviving sepsis campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infect Dis, 2012,12(12):919-924.
