本文關(guān)鍵詞： 腎結(jié)石 輸尿管鏡檢查 全身炎癥反應(yīng)綜合征 影響因素分析　出處：《中國全科醫(yī)學(xué)》2017年17期 　論文類型：期刊論文

【摘要】：目的探討輸尿管軟鏡鈥激光碎石術(shù)治療腎盞憩室結(jié)石術(shù)后全身炎癥反應(yīng)綜合征(SIRS)和殘石存在發(fā)生情況。方法選取2012年9月—2015年7月鄭州大學(xué)第二附屬醫(yī)院診斷為腎盞憩室結(jié)石的患者共30例為研究對象,所有患者經(jīng)腎-輸尿管-膀胱攝影(KUB)+靜脈腎盂造影(IVP)或CT尿路造影(CTU)檢查后診斷為腎盞憩室結(jié)石并行輸尿管軟鏡鈥激光碎石術(shù)治療。記錄術(shù)后SIRS發(fā)生情況,術(shù)后1個月及3個月復(fù)查雙腎CT平掃了解殘石存在情況。結(jié)果手術(shù)時間(67.3±21.2)min,術(shù)中出血量(7.0±4.1)ml,術(shù)后住院天數(shù)(4.1±2.7)d。術(shù)后發(fā)生SIRS 6例(20.0%),給予積極抗感染、補液等對癥處理后均未發(fā)生尿膿毒血癥及感染性休克。術(shù)后1個月殘石存在6例,殘石存在率為20.0%;術(shù)后3個月殘石存在5例,殘石存在率為16.7%。不同性別、年齡、結(jié)石直徑、結(jié)石位置、結(jié)石數(shù)量、腎盂腎盞夾角患者SIRS發(fā)生情況比較,差異均無統(tǒng)計學(xué)意義(P0.05);是否合并糖尿病、術(shù)中有無感染跡象、是否有感染性結(jié)石成分患者SIRS發(fā)生情況比較,差異均有統(tǒng)計學(xué)意義(P0.05)。不同性別、年齡、結(jié)石直徑、結(jié)石數(shù)量、是否合并糖尿病、術(shù)中有無感染跡象、是否有感染性結(jié)石成分患者術(shù)后殘石存在發(fā)生情況比較,差異均無統(tǒng)計學(xué)意義(P0.05);不同結(jié)石位置、腎盂腎盞夾角患者術(shù)后殘石存在發(fā)生情況比較,差異均有統(tǒng)計學(xué)意義(P0.05)。結(jié)論輸尿管軟鏡鈥激光碎石術(shù)是目前治療腎盞憩室結(jié)石比較安全、有效的方法之一,但對有發(fā)生SIRS危險因素的患者要注意術(shù)后感染的防治。對有殘石存在危險因素的患者要做好術(shù)前手術(shù)方式的選擇及術(shù)后排石的工作。
[Abstract]:Objective to investigate the occurrence of systemic inflammatory response syndrome (SIRS) and residual stone after ureteral soft endoscope holmium laser lithotripsy in the treatment of calyceal diverticulum calculi. A total of 30 patients with Calendula diverticulum calculi were studied. All patients were treated with ureteral diverticulithiasis and ureteral soft endoscopy with holmium: YAG laser lithotripsy after renal uretero-cystoscopy (KUB) intravenous pyelography (IVP) or CT urography (CTU). The incidence of SIRS after operation was recorded. Results the operative time was 67.3 鹵21.2 min, the intraoperative bleeding volume was 7.0 鹵4.1 ml, and the postoperative hospital stay was 4.1 鹵2.7 days. SIRS occurred in 6 cases (20.0%). There were no urinary sepsis and septic shock after resuscitation, 6 cases had residual stone and 20.0 residual stone, 5 cases had residual stone and 16.7T, different sex, age, diameter of stone, 3 months after operation, There was no significant difference in the location of stones, the number of stones and the incidence of SIRS in patients with renal pelvis and calyceal angle. The difference was statistically significant (P 0.05). A comparison of the occurrence of residual stone in patients with different sex, age, stone diameter, stone number, diabetes mellitus, infection during operation, and residual stone after operation was made. There was no significant difference between the two groups (P 0.05), and there was no significant difference in the occurrence of residual stone in patients with different stone locations and the angle between renal pelvis and calyceal. Conclusion the ureteral soft endoscope holmium: YAG laser lithotripsy is a safe method for the treatment of calculus in calyceal diverticulum. One of the effective methods is to pay attention to the prevention and treatment of postoperative infection in patients with SIRS risk factors.
【作者單位】： 鄭州大學(xué)第二附屬醫(yī)院泌尿外科;
【分類號】：R459.7;R699.2

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