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目的 探讨体外冲击波碎石 (ESWL)导致机体感染的可能性及测定尿液内毒素的价值和意义。方法 16 4例上尿路结石病人分成 5组。A组 :4 8例肾结石病人 ,结石 1- 4枚 (直径均≤ 2cm)。B组 :2 4例肾结石病人 ,结石 1- 3枚 (直径均 >2cm)。C组 :2 2例肾结石病人 ,结石 1- 3枚 ,伴 1- 2枚输尿管结石。D组 :51例输尿管结石病人 ,结石 1- 3枚 (直径为 0 5- 1 2cm)。E组 :19例复杂性肾结石病人。除A组外均有不同程度尿流梗阻。ESWL治疗前均无尿路感染。所有患者ESWL治疗前后取血、尿作细菌培养及以鲎试验测内毒素浓度。结果 所有病人ESWL治疗前、后血液内毒素浓度均无显著性变化 ,血液细菌培养均为阴性。B、C和E组ESWL治疗后尿液内毒素均较治疗前显著性升高。A和D组ESWL治疗前后尿液内毒素浓度均无显著性改变。ESWL治疗后B、C和E组尿液细菌培养阳性率较A和D组显著升高 ,或非常显著升高。结论 直径≤ 2cm、对引流系统无明显影响的肾结石或直径 0 5- 1 2cm的输尿管结石 ,ESWL治疗导致泌尿系感染的可能性较小 ;但复杂性、直径 >2cm的肾结石、或肾结石伴输尿管结石 ,即使ESWL治疗前无菌尿症 ,ESWL导致泌尿系感染的可能性大 ,预防性使用抗生素是必要的。另外 ,尿液内毒素测定是诊断ESWL病人泌尿系是否感染的一个
Objective To investigate the possibility of extracorporeal shock wave lithotripsy (ESWL) infection in the body and the value and significance of determination of endotoxin in urine. Methods 16 cases of upper urinary tract stones were divided into 5 groups. Group A: 48 patients with kidney stones, stones 1-4 (diameter ≤ 2cm). Group B: 24 cases of kidney stones, stones 1 - 3 (diameter> 2cm). Group C: 22 patients with kidney stones, stones 1 to 3, with 1 to 2 ureteral stones. Group D: 51 patients with ureteral calculi, stones 1 - 3 (diameter 0 5 -1 2cm). Group E: 19 patients with complicated kidney stones. In addition to A group have varying degrees of urinary obstruction. There was no urinary tract infection before ESWL treatment. Blood was taken before and after ESWL treatment in all patients, bacterial culture was performed in urine, and endotoxin concentration was determined by titers. Results All patients before and after ESWL treatment of blood endotoxin concentrations did not change significantly, blood culture were negative. The urine endotoxin of ESWL in groups B, C and E were significantly higher than those before treatment. There was no significant difference in urinary endotoxin concentrations between the A and D groups before and after ESWL treatment. The positive rates of urinary bacterial culture in groups B, C and E after ESWL treatment were significantly higher or significantly higher than those in groups A and D. CONCLUSIONS: Nephrolithiasis or ureteral calculi with a diameter of 5 to 12 cm have no significant effect on the drainage system. ESWL treatment is less likely to cause urinary tract infection. However, the complexity is that kidney stones with diameter> 2 cm or kidney Stones with ureteral calculi, ESWL even if the pre-treatment of sterile urine disease, ESWL lead to urinary tract infection is likely to prevent the use of antibiotics is necessary. In addition, the urine endotoxin test is one of the diagnoses of urinary tract infection in ESWL patients