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目的探讨输尿管结石继发严重上尿路感染的治疗方法与疗效。方法回顾性分析24例输尿管结石梗阻继发急性严重上尿路感染患者的临床治疗方法;在积极抗感染的同时,急诊行膀胱镜下逆行插管引流,或在B超引导下经皮肾穿刺置管引流,其中20例感染控制后二期行输尿管镜下碎石或体外冲击波碎石术(ESWL),3例在抗感染同时行ESWL,1例在抗感染同时行输尿管镜下气压弹道碎石术。结果 14例膀胱镜下逆行插管成功,6例在B超引导下行经皮肾穿刺造瘘术成功,10例行ESWL成功。在抗感染同时一期行ESWL或输尿管镜的4例碎石成功。所有患者无输尿管穿孔、输尿管撕裂、严重出血等并发症。术后1～8周输尿管结石全部排净,平均住院28.5 d。结石排净后随访1～9个月,患者肾功能全部恢复正常。结论膀胱镜下逆行插管引流或经皮肾穿刺造瘘引流联合输尿管镜下碎石或ESWL简便,耐受性好,并发症少,可迅速控制感染,清除结石,二者联合应用是输尿管结石继发急性严重上尿路感染的理想治疗方法。
Objective To investigate the treatment and efficacy of ureteral calculi secondary to severe upper urinary tract infection. Methods A retrospective analysis of 24 cases of ureteral calculi obstruction secondary to acute upper urinary tract infection in patients with clinical treatment; active anti-infection at the same time, emergency retrograde cystoscopic retrograde intubation, or in the B-guided percutaneous renal puncture Among them, 20 cases underwent post-infection control with ureteroscopic lithotripsy or extracorporeal shock wave lithotripsy (ESWL), 3 cases with ESWL while anti-infective and 1 case with anti-infective ureteroscopic pneumatic ballistic crushing Stone surgery. Results The retrograde intubation of 14 cases under cystoscopy was successful. Six cases underwent percutaneous nephrolithotomy under B-guided ultrasonography, and 10 cases achieved ESWL success. In the anti-infective line ESWL or ureteroscopic 4 cases of gravel success. All patients without ureter perforation, ureteral tear, severe bleeding and other complications. Ureteral stones were all drained from 1 to 8 weeks after operation, with an average hospitalization of 28.5 days. Follow-up 1 to 9 months after the stones were drained, all patients with renal function returned to normal. Conclusions Cystoscopy retrograde intubation or percutaneous nephrostomy drainage combined with ureteroscopic lithotripsy or ESWL is simple, well tolerated, less complications, infection can be controlled quickly, remove stones, the combination of the two is ureteral calculi Followed by the ideal acute upper urinary tract infection treatment.