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目的探讨急性输尿管结石梗阻合并严重感染的微创治疗方法与疗效。方法对51例急性上尿路结石梗阻合并严重感染,在积极抗感染、纠正败血症和电解质紊乱的同时,急诊行膀胱镜下逆行插管引流或B超引导下行经皮肾细针穿刺置管引流。感染控制后行输尿管镜下碎石或体外冲击波碎石术。结果8例膀胱镜下逆行插管成功,其余43例在超声引导下经皮肾微创穿刺造瘘术均一次成功。术中见高压混浊脓性尿液喷出,术后10例有暂时性血尿和腰痛,无气胸、尿外渗、肾周血肿、腹腔脏器损伤等并发症。3例术后造瘘管脱出重新置管。3~7d后所有患者体温和血白细胞数降至正常。结石处理:8例采用体外震波碎石术,35例行输尿管镜下气压弹道碎石术,8例结石上推至肾盂后行体外震波碎石。无输尿管穿孔、输尿管撕裂、严重出血及术后高热等并发症。术后3周内结石全部排净,其中1周内结石排净34例。51例术后随访3~6个月,患肾功能恢复正常。结论经皮肾微创穿刺造瘘引流联合输尿管镜取石或体外震波碎石可迅速控制感染,减少并发症,是急性输尿管结石梗阻伴严重感染的理想微创治疗方法。
Objective To investigate the minimally invasive treatment and efficacy of acute ureteral obstruction complicated with severe infection. Methods Fifty-one patients with acute upper urinary tract obstruction complicated with severe infection were treated with retrograde cystoscope retrograde catheterization or B-ultrasound guided percutaneous nephrolithotracheal tube drainage while actively fighting infection, correcting sepsis and electrolyte imbalance. . After infection control ureteroscopic lithotripsy or extracorporeal shock wave lithotripsy. Results 8 cases of retrograde intubation under cystoscopy succeeded, the remaining 43 cases under the guidance of ultrasound-guided percutaneous nephrostomy were successful. See intraoperative high-pressure turbidity purulent urine spray, postoperative 10 patients had temporary hematuria and low back pain, no pneumothorax, urinary extravasation, perirenal hematoma, abdominal organ injury complications. Three cases of fistula after surgery to re-catheterization. After 3 to 7 days, the temperature and blood leukocyte count decreased to normal in all patients. Stone treatment: 8 cases of extracorporeal shock wave lithotripsy, 35 cases of ureteroscopic pneumatic lithotripsy, 8 cases of stones pushed to the renal pelvis after extracorporeal shock wave lithotripsy. No ureter perforation, ureteral tear, severe bleeding and postoperative fever and other complications. All stones were drained completely within 3 weeks after operation, of which 34 were excluded in 1 week. 51 patients were followed up for 3 to 6 months, suffering from renal function returned to normal. Conclusion Percutaneous minimally invasive percutaneous nephrostomy drainage combined with ureteroscopic or extracorporeal shock wave lithotripsy can quickly control the infection and reduce complications. It is an ideal minimally invasive treatment for acute ureteral obstruction with severe infection.