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目的探讨经输尿管气压弹道碎石术后合并重症感染的早期诊疗方法,以减少经输尿管气压弹道碎石术后合并重症感染的发生。方法选择2012年1月-2015年12月收治的260例经输尿管气压弹道碎石术后合并重症感染患者为研究对象(观察组),另选同期经输尿管气压弹道碎石术后未发生感染的患者260例(对照组),比较两组患者的结石直径、尿液检查情况、术前感染情况、输尿管镜操作时间、手术时间、术中出血、术中灌注压、术后引流、碎石成功率及结石清除率。结果观察组术前结石>15mm和尿液检查呈阳性的患者(207例、215例)多于对照组(32例、39例),差异有统计学意义(P<0.05);观察组术前感染未控制和术后引流不畅的患者(195例、179例)多于对照组(14例、27例),差异有统计学意义(P<0.05);观察组手术时间、输尿管镜操作时间[(72.19±14.31)min、(72.07±16.11)min]多于对照组[(65.14±12.01)min、(35.53±14.21)min],观察组术中出血量[(24.65±3.27)ml]多于对照组[(18.21±2.32)ml],观察组术中灌注压[(81.28±7.01)mmHg]高于对照组[(65.42±6.73)mmHg],差异有统计学意义(P<0.05);观察组患者碎石成功率和结石排除率(77.31%、70.00%)均低于对照组(88.85%、82.31%),差异均有统计学意义(P<0.05)。结论结石直径较大、尿检阳性、术前感染未控制、手术时间过长、输尿管镜操作时间、术中出血量过多、术中灌注压过高、术后引流不畅易导致输尿管气压弹道碎石术后合并重症感染发生,在早期诊断和治疗过程中应给予有效的抗感染治疗,提高碎石技巧以及加强术后护理。
Objective To investigate the early diagnosis and treatment of severe infection after ureteral pneumatic lithotripsy to reduce the incidence of severe infection after ureteral pneumatic lithotripsy. Methods From January 2012 to December 2015, 260 patients with severe infection after ureteral pneumatic lithotripsy were enrolled in this study (observation group). The other patients who underwent ureteral pneumatic lithotripsy without infection 260 patients (control group) were enrolled in this study. The diameter of stones, urinalysis, preoperative infection, ureteroscopic operation time, operative time, intraoperative bleeding, intraoperative perfusion pressure, postoperative drainage and gravel were compared between the two groups Rate and stone clearance rate. Results In the observation group, the number of patients with preoperative stone> 15mm and urine test was significantly higher than that of the control group (207 cases, 215 cases) (32 cases, 39 cases), the difference was statistically significant (P <0.05) (195 cases, 179 cases) were more than those in control group (14 cases, 27 cases), the difference was statistically significant (P <0.05); the operation time of the observation group, ureteroscopic operation time (72.19 ± 14.31) min and (72.07 ± 16.11) min in the observation group were significantly higher than those in the control group [(65.14 ± 12.01) min and (35.53 ± 14.21) min, respectively In the control group [(18.21 ± 2.32) ml], the intraoperative perfusion pressure (81.28 ± 7.01 mmHg) in the observation group was significantly higher than that in the control group (65.42 ± 6.73 mmHg) (P <0.05). The success rate of lithotripsy and stone removal in the observation group (77.31%, 70.00%) were lower than those in the control group (88.85%, 82.31%), the differences were statistically significant (P <0.05). Conclusion The larger diameter of stones, positive urine test, uncontrolled preoperative infection, long operation time, ureteroscopic operation time, excessive intraoperative blood loss, intraoperative perfusion pressure is too high, easily lead to poor drainage after ureteral pneumatic ballistic Stone surgery combined with severe infection, in the early diagnosis and treatment should be given effective anti-infective therapy, improve the skills of gravel and strengthen postoperative care.