摘要
目的通过向术侧肾脏集合系统灌注聚维酮碘联合负压吸引鞘一期处理非急性感染期的上尿路结石合并肾积脓病人,以期减少病人术后系统性炎性反应综合征(SIRS)、脓毒血症的发生。方法 2019年4月~2019年8月我科行一期经皮肾镜取石术(PCNL)的上尿路结石合并肾积脓病人5例。术前符合以下任一条者预纳入分析,包括尿亚硝酸盐阳性、尿培养阳性、腹部CT平扫考虑肾脓性感染或小便反复浑浊伴尿白细胞明显增高。术中超声引导下经皮肾穿刺后证实引流出脓性尿者5例,含4例术前48小时尿培养阳性者,对上述5例病人分别从清石率、肝肾功能、炎性反应及感染指标、手术及碎石时长、并发症方面进行观察评估。结果聚维酮碘灌注法PCNL联合负压吸引鞘一期处理的肾输尿管结石合并肾积脓病人有4例达到一期清石效果,1例因结石负荷重接受二期输尿管软镜手术。所有病人围术期肝肾功能指标比较,差异均无统计学意义(P<0.05)。术前血降钙素原、C反应蛋白(CRP)水平与术后比较,差异均无统计学意义(P<0.05)。无一例发生脓毒血症,有1例发生SIRS且持续3小时经抗感染治疗后病情好转;平均碎石及手术时长分别为39分钟、60分钟;无穿刺损伤、严重出血、输尿管损伤及过敏反应等并发症。结论聚维酮碘灌注法PCNL联合负压吸引鞘一期处理肾输尿管结石合并肾积脓的手术方式能减少住院时间及留置肾造瘘时间,保证了碎石的安全性和有效性。
Objective To reduce the incidence of SIRS and sepsis in patients with upper urinary tract calculi and pyonephrosis in non-acute infection stage by perfusion of povidone iodine and negative pressure aspiration sheath into the renal collecting system on the surgical side.Methods The clinical data of PCNL patients with pyonephrosis and upper urinary calculi from April 2019 to August 2019 were retrospectively analyzed.5 cases were actually included.Those who met any of the following conditions before operation were included in the analysis,including positive nitrite in urine,positive urine culture,abdominal CT plain scan considering pyonephritis or repeated turbidity of urine with significant increase of urinary white blood cells.Ultrasound-guided percutaneous nephrolithotomy confirmed the drainage of purulent urine in 5 cases,including 4 cases with positive urine culture 48 hours before operation.Negative pressure of these 5 cases was evaluated in terms of lithotripsy rate,liver and kidney function,inflammation and infection index,length of operation and lithotripsy and complications.Results 80%(4/5) of the patients with ureterolithiasis and pyonephrosis treated by the above method in the first stage achieved the effect of primary lithotripsy.One patient underwent stage Ⅱ flexible ureteroscopic surgery because of the stone burden;all patients had no perioperative liver and kidney function damage(P<0.05).Preoperative procalcitonin level and preoperative blood C-reactive protein(CRP) level compared with postoperative had not significantly different(P<0.05).No sepsis occurred in one case,SIRS occurred in one case and improved after anti-infection treatment for 3 hours.The average length of lithotripsy and operation were 39 minutes and 60 minutes,respectively.No complications such as puncture injury,severe bleeding,ureteral injury and allergic reaction occurred.Conclusion PCNL combined with negative pressure aspiration sheath for primary treatment of renal and ureteral calculi complicated with pyonephrosis by povidone iodine perfusion can reduce hospitalization time and avoid long-term indwelling nephrostomy,while ensuring the safety and effectiveness of lithotripsy.
作者
王新光
李瑞
夏丁
王珅
杨欢
陈亮
彭鄂军
杨为民
陈志强
WANG Xinguang;LI Rui;XIA Ding(Department of Urology,Tongji Hispital,Tongji Medical college,Huazhong University of science and Technology,Wuhan 430030,China)
出处
《临床外科杂志》
2020年第12期1167-1170,共4页
Journal of Clinical Surgery
关键词
聚维酮碘
脓肾
负压吸引鞘
脓毒血症
povidone iodine
pyonephrosis
negative pressure aspiration sheath
sepsis
