Comparison of the therapeutic effect between percutaneous nephrostomy and ureteral stent placement in the urinary sepsis
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摘要: 目的 比较微通道经皮肾造瘘术与经尿道输尿管内支架管置入引流输尿管结石所致感染性肾内积液的临床疗效，探讨肾盂积液CT值在早期干预尿源性脓毒症的临床价值。方法 收集2015年1月—2021年11月我院收治的上尿路结石所致尿源性脓毒症患者110例，其中行经尿道输尿管支架管置入(输尿管支架组)54例，行B超引导下微通道经皮肾造瘘术(肾造瘘组)56例。比较2种治疗方案的手术时间、置管成功率、感染控制时间、引流液细菌培养阳性率及手术安全性等。以肾盂积液CT值12 HU为界，比较2种方案的感染控制时间。结果 肾造瘘组平均手术时间为(17.04±5.49) min、平均感染控制时间为(5.41±0.93)d，均显著少于输尿管支架组的(26.74±8.0) min、(6.26±0.94) d，差异有统计学意义(P < 0.05)；肾造瘘组引流液培养阳性率显著高于输尿管支架组，差异有统计学意义(P < 0.05)。以肾盂积液CT值12 HU为界，当肾盂CT值< 12 HU时，2组感染控制时间差异无统计学意义(P>0.05)；当肾盂CT值≥12 HU时，肾造瘘组感染控制时间为5.29 d，显著低于输尿管支架组的6.67 d(P < 0.05)。结论 经皮肾穿刺造瘘和输尿管内引流对于输尿管结石所致脓毒症均有良好效果。对于肾盂积液CT值≥12 HU，经皮肾微通道造瘘疗效优于输尿管内支架管置入引流，更适合于尿源性脓毒症的早期引流。Abstract: Objective To compare the clinical efficacy between nephrostomy and ureteral stent placement in the treatment of ureteral calculi-induced urinary sepsis, and to explore the clinical value of CT value of renal pelvic effusion in early intervention of urinary sepsis.Methods We collected 110 patients with urinary sepsis caused by ureteral stones who were admitted to the Haixia Hospital of Huaqiao University from January 2015 to November 2021. Fifty-four cases underwent ureteral stent placement(USP) and the other 56 cases underwent minimal invasive percutaneous nephrostomy(MIPN) under ultrasound guidance. Clinical data including the operation time, infection control time, positive rate of bacterial culture, surgical safety were compared between two groups. CT value of renal effusion of 12 HU was set as critical value, then the duration from intervention to the point when sepsis was under control between the two groups was compared.Results The operation time of the MIPN group was less than that of the other group([17.04±5.49]min vs [26.74±8.0]min, P < 0.05), and the infection control duration in MIPN group was less than that of the other group([5.41±0.93]d vs [6.26±0.94]d, P < 0.05). The difference between two groups was statistically significant(P < 0.05). The positive rate of urine culture in the MIPN group was higher than that in the USP group, and the difference was statistically significant(P < 0.05). In our investigation, the CT value 12 HU of renal pelvis effusion was set as the critical value. When patients'CT values were less than 12 HU, there was no significant difference of infection control duration between the two groups(P>0.05), while the CT value of renal pelvic effusion>12 HU, the infection control duration of the nephrostomy group was less than the other group(5.29 vs 6.67 days, P < 0.05).Conclusion Percutaneous nephrostomy and ureteral drainage were both effective for the treatment of sepsis secondary to ureteral calculi. In the patients whose CT value of renal pelvis effusion greater than 12 HU, MIPN was more effective than USP as an clinical procedure for early intervention of urinary sepsis.
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Key words:
- percutaneous nephrostomy /
- ureteral stent /
- CT value /
- sepsis
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表 1 2组患者一般资料比较
例，X ± s 临床资料 肾造瘘组(56例) 输尿管支架组(54例) t/F P值 年龄/岁 52.00±7.06 54.04±7.62 -1.455 0.149 性别 0.297 0.586 男 21 23 女 35 31 BMI/(kg/m2) 25.80±3.69 26.50±4.10 -0.493 0.626 结石大小/cm 1.93±0.36 1.82±0.43 1.441 0.053 血白细胞/(×109/L) 16.42±5.40 19.40±10.46 -1.868 0.066 中性粒比/% 85.19±6.57 85.85±6.40 -0.536 0.593 CRP/(mg/L) 159.98±70.07 145.76±76.23 1.019 0.311 PCT/(ng/mL) 20.08±36.22 19.68±22.74 0.07 0.944 集合系统分离/cm 4.05±1.80 3.50±1.28 1.844 0.068 尿白细胞阳性 46 48 1.007 0.316 合并高血压 23 20 0.188 0.665 合并糖尿病 21 16 0.763 0.382 
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表 2 2组患者疗效比较
例，X ± s 组别 例数 手术时间/min 感染控制时间/d 置管成功例数 引流液细菌培养阳性例数 阳性菌群(大肠杆菌/克雷伯杆菌/其他菌) 肾造瘘组 56 17.04±5.49 5.41±0.93 56 27 20/4/3 输尿管支架组 54 26.74±8.00 6.26±0.94 44 15 11/3/1 t/χ2 -7.391 -4.770 4.864 4.317 P值 <0.001 0.001 0.010a) 0.027 0.229 注：a)采用Fisher精确检验。
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表 3 2组患者手术安全性及术后生活质量比较
例 组别 例数 2 h感染进展 出血 肾盂输尿管穿孔 脱管 术后腰痛 肾造瘘组 56 2 4 0 0 16 输尿管支架组 54 6 1 3 1 4 χ2 1.334 0.764 6.63 P值 0.248 0.382 0.115a) 0.091a) 0.010 注：a)采用Fisher精确检验。
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表 4 不同肾盂CT值的2组患者感染控制时间比较
X ± s CT值 肾造瘘组 输尿管支架组 t P值 例数 感染控制时间/d 例数 感染控制时间/d <12 HU 22 5.59±0.91 33 6.00±0.79 -1.771 0.082 ≥12 HU 34 5.29±0.94 21 6.67±1.02 -5.106 0.001
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