论文部分内容阅读
目的:探讨孤立肾结石患者接受电子输尿管软镜钬激光碎石术后出现尿脓毒血症的临床特点及治疗方法。方法:回顾性分析孤立肾结石患者行电子输尿管软镜钬激光碎石术后出现尿脓毒血症的5例患者的临床资料:2例为单侧肾切除术后,3例为功能性孤立肾。结石位于肾下盏3例,多肾盏2例;结石大小20~31mm,平均25mm。术前3例患者尿培养阳性,其中2例为大肠埃希氏菌,1例为克雷伯杆菌。患者经由同一术者在全麻下行电子输尿管软镜钬激光碎石术。结果:5例患者术后出现不同程度尿脓毒血症。经及时进行有效液体复苏,选用敏感抗生素或亚胺培南,并选用小剂量短期地塞米松及血管活性药物等对症支持治疗,术后1周内均逐渐恢复,痊愈出院。结论:尿脓毒血症是上尿路结石腔内治疗后的严重并发症之一。充分的术前准备,熟练的手术操作,严密的术后监测,早期发现和及时有效的治疗,是防治孤立肾结石电子输尿管软镜钬激光碎石术后出现尿脓毒血症的有效措施。
Objective: To investigate the clinical features and treatment of urethral septicemia in patients with solitary renal calculus after receiving ureteroscopic holmium laser lithotripsy. Methods: The clinical data of 5 patients with urethral septicemia after ureteroscopic holmium laser lithotripsy in patients with solitary renal calculus were analyzed retrospectively: 2 cases were functional isolated after unilateral nephrectomy kidney. The stones were located in the lower part of the kidney in 3 cases, multiple calyces in 2 cases; stone size 20 ~ 31mm, an average of 25mm. Urine cultures were positive in 3 patients before surgery, of which 2 were Escherichia coli and 1 was Klebsiella. Patients under the same operation under general anesthesia with electronic ureteroscopic holmium laser lithotripsy. Results: 5 cases of postoperative urinary sepsis to varying degrees. After timely effective liquid resuscitation, the use of sensitive antibiotics or imipenem, and the use of small doses of short-term dexamethasone and vasoactive drugs and other symptomatic and supportive treatment, within 1 week after surgery were gradually recovered and discharged. Conclusion: Uremic sepsis is one of the serious complications after endovascular calculi in upper urinary tract. Adequate preoperative preparation, skilled surgical operation, close postoperative monitoring, early detection and timely and effective treatment are effective measures to prevent and treat urinary sepsis after solitary renal calculus ureteroscopic holmium laser lithotripsy.