摘要
目的:探讨输尿管结石继发严重上尿路感染的治疗方法与疗效。方法:回顾性分析32例输尿管结石梗阻继发急性严重上尿路感染患者的临床治疗方法:在积极抗感染的同时,急诊行膀胱镜下逆行插管引流,或在B超引导下经皮肾穿刺置管引流,其中27例感染控制后二期行输尿管镜下碎石或ESWL,3例在抗感染同时行ESWL,2例在抗感染同时行输尿管镜下气压弹道碎石术。结果:19例膀胱镜下逆行插管成功,8例在B超引导下行经皮肾穿刺造瘘术成功,3～6天后患者体温和血白细胞数降至正常。二期14例行输尿管镜下气压弹道碎石术成功,13例行ESWL成功。在抗感染同时一期行ESWL或输尿管镜的5例碎石成功。所有患者无输尿管穿孔、输尿管撕裂、严重出血等并发症。术后1～8周输尿管结石全部排净,平均住院28.5天。结石排净后随访1～9个月,患肾功能全部恢复正常。结论:膀胱镜下逆行插管引流或经皮肾穿刺造瘘引流联合输尿管镜下碎石或ESWL简便,耐受性好,并发症少,可迅速控制感染,清除结石,二者联合应用是输尿管结石继发急性严重上尿路感染的理想治疗方法。
Objective：To evaluate the treatment method and efficacy of treatment for severe upper urinary tract infection caused by ureteral calculi. Methods： The cinical data of 32 patients with severe acute upper urinary tract infection caused by ureteral calculi were reviewed. With active anti-- infection, the emergent cystoscopic retrograde ureteral catheterization or B ultrasound guided percutaneous nephrostomy was carried out. Ureteroscopic lithotripsy （USL） or extracorporeal shockwave lithotripsy （ESWL） was performed after the infection was completely controlled in 27 cases. Before the infection was fully controlled, ESWL was performed in 3 cases, and USL was in performed in 2 cases. Results：Cystoscopic retrograde ureteral catheterization was accomplished in 19 cases, and 8 cases were treated successfully by percutaneous nephrostomy guided by B ultrasonography. In all patients, the body temperature and white blood cell counts returned to the normal range in 3 to 6 days after the drainage. 14 cases received USL, and 13 cases were treated with ESWL. The outcome of the 5 cases who underwent USL or ESWL before the infection was fully controlled were also satisfactory. No severe complications, such as ureteral perforation or tear, massive hemorrhage occurred. The stones were completely removed in all the cases in 1 to 8 weeks after the operations. The average time of hospitalization was 28.5 days. The patients were followed up for 1 to 9 months, during which the renal function recovered to the normal level. Conclusions：Retrograde ureteral catheterization using cystoscopy or percutaneous nephrostomy guided by B uhrasonography combined with USL or ESWL is efficient for patients with severe acute upper urinary tract infection caused by ureteral calculi. By these means, infection can be controlled and stones be removed quickly without causing severe complications.
出处
《临床泌尿外科杂志》
北大核心
2009年第7期520-521,526,共3页
Journal of Clinical Urology
关键词
输尿管结石
泌尿系感染
ureteral calculus
urinary tract infection
