妊娠期输尿管结石合并急性肾盂感染置入输尿管双J管治疗效果及安全性分析

发布时间：2018-07-20 12:44

【摘要】：目的分析妊娠期输尿管结石合并急性肾盂感染患者置入输尿管双J管进行治疗的效果及安全性,为临床治疗提供依据。方法选取2011年6月-2016年6月医院收治的行经尿道输尿管镜手术治疗的妊娠期输尿管结石合并急性肾盂感染患者66例,所有患者在给予抗感染治疗的同时采用输尿管镜下置入双J管治疗,部分结石位置较好及术中感染无进一步加重,生命体征稳定者,予以一期行钬激光下碎石取石术,观察其治疗效果及安全性。结果 6例妊娠期输尿管结石合并急性肾盂感染患者在行输尿管镜下置入双J管治疗后,体温在1~4d内恢复正常,白细胞计数在3~6d内恢复正常;与置管前比较,所有患者置管后其C-反应蛋白及前降钙素水平均明显降低,差异均有统计学意义(P0.05);5例患者术前即出现感染性休克,均及时转入ICU进行抗感染治疗;感染控制后均成功进行了输尿管置管或钬激光碎石治疗,对急性肾盂感染的病因给予解除;所有患者内置双J管2~8个月后进行拔除;对所有患者随访至分娩,其中4例患者自行要求引产,其余患者均顺利生产,且均未发生严重产科并发症。结论妊娠期输尿管结石合并急性肾盂感染置入输尿管双J管治疗安全且有效,尽早采取输尿管双J管置入能够为下一步输尿管结石处理创造有利条件。
[Abstract]:Objective to analyze the efficacy and safety of ureteral double J tube placement in patients with ureteral calculi complicated with acute pyelitis during pregnancy, so as to provide evidence for clinical treatment. Methods from June 2011 to June 2016, 66 patients with ureteral calculi complicated with acute renal pelvis infection were treated by transurethral ureteroscopy. All the patients were treated with double J tube under ureteroscope while anti-infective therapy was given. If the site of some stones was better and the infection was not further aggravated during operation, the patients with stable vital signs were treated with holmium laser lithotripsy at one stage, and the patients were treated with holmium laser lithotripsy. The therapeutic effect and safety were observed. Results in 6 cases of ureteral calculi complicated with acute pyelitis during pregnancy, the body temperature returned to normal within 1 ~ 4 days and the white blood cell count returned to normal within 3 ~ 6 days after ureteroscopy with double J tube placement, which was compared with that before catheterization. The levels of C- reactive protein and procalcitonin in all patients were significantly decreased after catheterization (P0.05) 5 patients had septic shock before operation and were transferred to ICU in time for anti-infection therapy. After infection control, ureteral catheterization or holmium laser lithotripsy was successfully performed to relieve the etiology of acute pyelitis; all patients were removed after 2 to 8 months of built-in double J tube; all patients were followed up until delivery. Among them, 4 cases were required to induce labor by themselves, and all the other cases were born smoothly, and no severe obstetric complications occurred. Conclusion it is safe and effective to place ureteral double J tube in pregnancy ureteral calculi complicated with acute renal pelvis infection. Early placement of ureteral double J tube can create favorable conditions for the next step of ureteral calculi treatment.
【作者单位】：余姚市人民医院泌尿外科;余姚市人民医院妇产科;宁波大学医学院;
【基金】：浙江省中西医结合学会科研基金项目(2013LYSX004)
【分类号】：R714.258

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