Efficacy analysis of Shuo Tong ureteroscopy on the treatment of upper ureteral calculi complicated with urinary tract infection
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摘要: 目的:探讨硕通镜治疗合并尿路感染的输尿管上段结石的临床疗效及安全性。方法:回顾性研究昆明医科大学第二附属医院2018年6~9月对39例合并尿路感染的输尿管上段结石行硕通镜治疗的临床资料。其中男26例,女13例,年龄25~77岁,平均年龄(46±13.8)岁,结石位于L2以上20例,位于L2~L4 19例,结石最大直径0.7~2.4 cm,平均(1.42±0.76) cm;肾积水范围约0.7~4.3 cm,平均(1.78±1.06) cm;结石CT值660~1 349 HU,平均(941.35±256.31)HU;尿液镜检白细胞++~++++,平均+++;术前血清降钙素原(PCT)0.062~1.268μg/L,C-反应蛋白(CRP)2.36~26.68 mg/L。39例患者均根据术前药敏试验选择敏感抗生素抗感染治疗。统计其一期置鞘成功率,手术时间、一期结石清除率、住院时间、术后PCT、CRP及术后并发症。结果:36例均顺利置入镜鞘成功率92.3%(36/39),2例置鞘失败改行2期硕通镜治疗,1例置鞘失败改为经皮肾镜;手术时间30~150 min,平均(72.11±40.81)min;一期结石清除率94.9%(37/39);术后住院时间4~10 d,平均(6.94±3.15)d;术后PCT 0.028~0.562μg/L,中位PCT 0.06μg/L;CRP 1.89~19.01 mg/L,中位CRP 5.20 mg/L;39例其中1例(2.6%)发生输尿管黏膜损伤,2例(5.1%)术后发热,经对症处理后治愈,无全身炎症反应综合征发生。结论:硕通镜治疗输尿管上段结石安全有效且结石清除率高,硕通镜有可能作为治疗合并尿路感染的输尿管上段结石的首选方法。Abstract: Objective: To investigate the clinical efficacy and safety of Shuo Tong ureteroscopy in the treatment of upper ureteral calculi with urinary tract infection. Method: The clinical data of 39 patients with upper ureteral calculi complicated with urinary tract infection treated by Shuo Tong ureteroscopy from June 2018 to September 2018 were retrospectively analyzed in Second Affiliated Hospital of Kunming Medical University including 26 male cases and 13 female cases. Their age was 25-77 years old, averaging(46±13.8). Stones located in the above L2 in 20 cases, located between L2-L4 in 19 cases. The maximum diameter of the stone was about 0.7-2.4 cm, averaging(1.42±0.76) cm, and the range of hydronephrosis was about 0.7-4.3 cm, averaging(1.78±1.06) cm. The CT value of the stone was 660-1 349 HU, averaging(941.35±256.31) HU. Urine microscopy showed white blood cell ++-++++, averaging +++. Preoperative PCT was 0.062-1.268 μg/L, and C-reactive protein was 2.36-26.68 mg/L. All 39 patients were selected for antibiotic treatment according to preoperative susceptibility testing. The success rate of one-stage sheathing, operation time, first-stage stone removal rate, hospitalization time, postoperative PCT, C-reactive protein and postoperative complications were recorded. Result: The success rate of one-stage sheathing was 92.3%(36/39), for 2 cases were changed to second-stage Shuo Tong ureteroscopy treatment and 1 case was changed to percutaneous nephrolithotomy. The operation time was 30-150 min, averaging(72.11±40.81) min, and the clearance rate of first-stage was 94.9 %(37/39). Postoperative hospitalization time was 4-10 days, averaging(6.94±3.15) days. Postoperative PCT was 0.028-0.562 μg/L, median 0.06 μg/L and C-reactive protein was 1.89-19.01 mg/L, median 5.20 mg/L. One case(2.6%) had ureteral mucosal injury, and 2 cases(5.1%) had postoperative fever. No systemic inflammatory response syndrome occurred after symptomatic treatment.Conclusion: Shuo Tong ureteroscopy is safe and effective for the treatment of upper ureteral calculi with high stone removal rate, so it may be the first choice for the treatment of upper ureteral calculi with urinary tract infection.
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Key words:
- Shuo Tong ureteroscopy /
- upper ureteral calculi /
- urinary tract infection
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