摘要
目的比较内引流术与外引流术处理输尿管结石梗阻所致尿源性脓毒血症的效果。方法回顾性分析河源市人民医院2015年1月至2020年9月收治的76例因输尿管结石梗阻所致尿源性脓毒血症患者的诊疗情况,根据手术方法分为内引流组42例和外引流组34例。外引流组患者采用经皮肾穿刺造瘘引流术治疗,内引流组患者采用输尿管镜直视下逆行置入双J管引流术治疗。治疗后,比较两组患者的引流成功率,腰痛缓解时间、术后下床时间、手术时间、术后体温恢复正常、白细胞计数(WBC)、中性粒细胞比例(NEUR)、C反应蛋白(CRP)和降钙素原(PCT)水平以及不良反应发生情况。结果治疗后,内引流组患者的引流成功率为95.24%,明显高于外引流组的79.41%,差异均有统计学意义(P<0.05);内引流组患者的手术时间、术后体温恢复正常时间、腰痛缓解时间和术后下床时间分别为(16.05±4.31)min、(1.21±0.54)d、(1.12±0.04)d、(1.01±0.21)d,明显短于外引流组的(20.92±6.47)min、(2.35±0.67)d、(3.21±0.26)d、(3.08±0.46)d,差异均有统计学意义(P<0.05);治疗前,两组患者的WBC、NEUR、CRP和PCT水平比较差异均无统计学意义(P>0.05);治疗后3 d,两组患者的WBC、NEUR、CRP和PCT水平均明显降低,且内引流组患者的WBC、NEUR、CRP和PCT水平分别为(8.16±2.84)×10^(9)/L、(68.16±5.41)%、(1.54±0.16)mg/L、(0.17±0.03)μg/L,明显低于外引流组的(12.63±2.54)×10^(9)/L、(79.34±5.41)%、(5.27±1.93)mg/L、(0.82±0.27)μg/L,差异均有统计学意义(P<0.05);内引流组患者的并发症总发生率为4.76%,明显低于外引流组的29.41%,差异有统计学意义(P<0.05)。结论输尿管镜直视下逆行置入双J管引流术治疗输尿管结石梗阻所致尿源性脓毒血症可有效预防患者术后感染及严重并发症的发生,临床应用效果显著,值得推广应用。
Objective To study the effect of internal drainage and external drainage in the treatment of urinary sepsis caused by ureteral stone obstruction.Methods Retrospective analysis was made on the diagnosis and treatment of 76 patients with ureteral sepsis caused by ureteral stone obstruction who were admitted to Heyuan People's Hospitalfrom January 2015 to September 2020.According to the surgical methods,they were divided into internal drainage group(n=42)and external drainage group(n=34).Patients in the external drainage group were treated with percutaneous nephrostomy and drainage,and patients in the internal drainage group were treated with retrograde double J tube drainage under ureteroscopy and direct vision.After treatment,the success rate of drainage,the relief time of low back pain,postoperative time out of bed,operative time,postoperative body temperature return to normal,white blood cell count(WBC),neutrophil proportion(NEUR),C-reactive protein(CRP)and procalcitonin(PCT)levels,and the incidence of adverse reactions in two groups were compared.Results After treatment,the success rate of drainage in the internal drainage group was 95.24%,which was significantly higher than 79.41%in the external drainage group(P<0.05);the operation time,postoperative temperature return to normal time,low back pain relief time,and postoperative bed time in the internal drainage group were(16.05±4.31)min,(1.21±0.54)d,(1.12±0.04)d,and(1.01±0.21)d,respectively,which were significantly shorter than corresponding(20.92±6.47)min,(2.35±0.67)d,(3.21±0.26)d and(3.08±0.46)d in the external drainage group(all P<0.05);the levels of WBC,NEUR,CRP,and PCT in the internal drainage group were(8.16±2.84)×10^(9)/L,(68.16±5.41)%,(1.54±0.16)mg/L,(0.17±0.03)μg/L,respectively,which were significantly lower than corresponding(12.63±2.54)×10^(9)/L,(79.34±5.41)%,(5.27±1.93)mg/L,(0.82±0.27)μg/L in the external drainage group(all P<0.05);the total incidence of complications was 4.76%,which was significantly lower than 29.41%in the external drainage group(P<0.05).Conclusion The retrograde double J tube drainage under ureteroscopy for the treatment of ureteral sepsis caused by ureteral stone obstruction can effectively prevent the occurrence of postoperative infection and serious complications,and the clinical application is significant,which is worthy of promotion and application.
作者
付星
江春强
黄考平
温世和
FU Xing;JIANG Chun-qiang;HUANG Kao-ping;WEN Shi-he(Department of Urology Surgery,the People's Hospital of Heyuan City,Heyuan 517000,Guangdong,CHINA)
出处
《海南医学》
CAS
2022年第4期427-430,共4页
Hainan Medical Journal
关键词
输尿管结石梗阻
尿源性脓毒血症
内引流术
外引流术
并发症
成功率
Ureteral stone obstruction
Urinary sepsis
Internal drainage
External drainage
Complications
Success rate
