| 摘要: |
| 目的 分析入院后不同时间段行经尿道留置输尿管支架管（D-J管）或经皮肾穿刺造瘘术（PCN）引流治疗上尿路结石伴感染的有效性和最佳引流时机。方法 纳入2018年1月至2019年12月收治入院的104例上尿路结石伴感染患者，根据引流方式随机分为经尿道留置D-J管组（D-J管组）和PCN组，再根据患者入院至手术时间依次进入≤2 h、>2～12 h和>12～24 h亚组（两组3个亚组均依次入组24、18和10例）。分析患者术前及术后1～3 d的体温、血常规白细胞计数和中性粒细胞比例、CRP、血清降钙素原、尿常规白细胞计数及术后体温恢复正常所需时间。结果 两组患者均顺利完成手术，均未更改手术方式。术后1 d，两组各亚组患者尿常规白细胞计数均较术前增多（P均<0.05）；D-J管组各亚组患者体温、血常规白细胞计数和中性粒细胞比例、CRP、血清降钙素原均高于PCN组各亚组患者，尿常规白细胞计数低于PCN组各亚组患者（P均<0.05）；两组患者中，>12～24 h亚组患者体温、血常规白细胞计数和中性粒细胞比例、CRP、血清降钙素原、尿常规白细胞计数均高于≤2 h亚组和>2～12 h亚组，差异均有统计学意义（P均<0.05）。术后2 d，PCN组各亚组患者体温、血常规白细胞计数和中性粒细胞比例、CRP、血清降钙素原及尿常规白细胞计数均低于D-J管组患者（P均<0.05）。术后3 d，两组各亚组患者的体温、血常规白细胞计数、血常规中性粒细胞比例、CRP、血清降钙素原均基本降至正常，但>12～24 h亚组上述指标均高于≤2 h和>2～12 h亚组，差异均有统计学意义（P均<0.05）。在患者体温恢复正常方面，两组≤2 h与>2～12 h亚组患者体温恢复正常所需时间差异均无统计学意义（P均>0.05），而D-J管组>12～24 h亚组患者体温恢复正常所需时间较PCN组患者长，差异有统计学意义（P<0.05）。结论 上尿路结石伴感染患者入院后12 h内行经尿道留置D-J管和PCN引流治疗均可获得较好疗效，但PCN术后感染控制效果更佳。 |
| 关键词: 上尿路结石 感染 输尿管支架置入术 经皮肾造瘘术 |
| DOI：10.16781/j.0258-879x.2020.10.1163 |
| 投稿时间：2020-06-19修订日期：2020-07-13 |
| 基金项目:上海市静安区市北医院课题（2020SBMS02），上海市浦东新区卫生和计划生育委员会特色专病项目（PWZzb2017-17）． |
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| Transurethral ureteral stent placement and percutaneous nephrostomy in drainage treatment of upper urinary calculi with infection: effectiveness and timing analyses |
| DENG Xiao-jun1,2,LI Yun1,ZHENG Jun-rong1,JU Jian-jun1,CAO Jian-wei3* |
(1. Department of Urology, Shibei Hospital of Jing'an District of Shanghai, Shanghai 200435, China;
2. Department of Urology, Shanghai Pudong New District Zhoupu Hospital, Shanghai 200283, China;
3. Department of Urology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University(Second Military Medical University), Shanghai 200438, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the effectiveness and the best drainage time of transurethral ureteral stent (D-J catheter) placement or percutaneous nephrostomy (PCN) in treating upper urinary tract calculi with infection at different time points after admission. Methods A total of 104 patients with upper urinary tract calculi and infection were enrolled in our hospital from Jan. 2018 to Dec. 2019. They were randomly divided into D-J catheter group and PCN group. According to the time from admission to operation, each group was then further divided into subgroups of ≤ 2 h, >2 h to 12 h and >12 h to 24 h (24, 18 and 10 cases, respectively). The body temperature, blood white blood cell (WBC) count and neutrophil proportion, C-reactive protein (CRP), serum procalcitonin, urine WBC count and the time of body temperature returning to normal were analyzed preoperatively and 1-3 d postoperatively. Results The patients in the two groups successfully received the operation with no change in operation mode. On the first day after the operation, the urine WBC counts were increased significantly in the three subgroups of each group (all P<0.05). The body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were significantly higher in the three subgroups of the D-J catheter group than those in the three subgroups of the PCN group, while the urine WBC count was significantly lower (all P<0.05). In the two groups, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and WBC count were significantly higher in the >12 h to 24 h subgroup than those in the ≤ 2 h and >2 h to 12 h subgroups (all P<0.05). On the second day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP, serum procalcitonin and urine WBC count were significantly lower in each subgroup of the PCN group than those in each subgroup of the D-J catheter group (all P<0.05). On the third day after the operation, the body temperature, blood WBC count and neutrophil proportion, CRP and serum procalcitonin were basically decreased to normals, but the above indexes were significantly higher in the >12 h to 24 h subgroup than those in the ≤ 2 h and >2 h to 12 h subgroups (all P<0.05). The time of body temperature returning to normal was similar between the ≤ 2 h and >2 h to 12 h subgroups of the two groups (all P>0.05), while the time in the >12 h to 24 h subgroup of the D-J catheter group was significantly longer than that of the PCN group (P<0.05). Conclusion Transurethral D-J catheter placement and PCN drainage within 12 h after admission can achieve good efficacy in treating patients with upper urinary tract calculi and infection, and the infection control of PCN is better. |
| Key words: upper urinary tract calculi infection ureteral stent placement percutaneous nephrostomy |
