2021 年第 6 期 第 16 卷

输尿管镜碎石术后并发重症感染的临床诊治策略分析

Clinical diagnosis and treatment strategies for severe infection after ureteroscopic lithotripsy

作者：李明川李青罗勇姜永光王永兴赵佳晖魏德超

英文作者：Li Mingchuan Li Qing Luo Yong Jiang Yongguang Wang Yongxing Zhao Jiahui Wei Dechao

单位：首都医科大学附属北京安贞医院泌尿外科100029

英文单位：Department of Urology Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：泌尿系结石；输尿管镜碎石术；感染

英文关键词：Urinarycalculi;Ureteroscopiclithotripsy;Infection

• 摘要：

• 目的 分析输尿管镜碎石术后并发重症感染的临床诊治策略。方法 回顾性分析2017年1月至2019年10月于首都医科大学附属北京安贞医院接受输尿管镜碎石术后并发重症感染的11例泌尿系结石患者的临床资料。记录患者性别、年龄、合并疾病、泌尿系结石发病情况、术前尿培养结果、手术时间、住院时间、术后发生一般脓毒血症例数及严重脓毒血症例数。结果 11例术后重症感染患者中男7例、女4例，年龄39～69岁、平均(49±11)岁；合并糖尿病者4例、高血压病者5例、心脏疾病者3例；单纯输尿管结石4例，单纯肾结石2例，肾结石合并输尿管结石5例；单侧病变9例，双侧病变2例。术前尿培养阳性4例，均术前给予口服抗感染药物3～7 d。手术采用输尿管硬镜、输尿管软镜或二者结合方式进行，手术时间35～190 min、平均（87±15）min，住院时间9～21 d、平均（15.1±1.2）d。术后一般脓毒血症患者8例，严重脓毒血症患者3例，后者中2例发生脓毒性休克。所有患者术后明确诊断后住院治疗5～16 d。2例术后转入感染科进行治疗。所有患者均康复出院，无死亡病例。结论 对于合并症多、结石负荷大、梗阻时间长、感染症状明显的患者应警惕术后发生重症感染的可能。术前充分抗感染引流，术中及术后注意早期临床征象的监测，及时应对治疗是输尿管镜碎石术后并发重症感染成功救治的关键。

• Objective To analyze clinical diagnosis and treatment strategies for severe infection after ureteroscopic lithotripsy. Methods From January 2017 to October 2019, clinical data of 11 patients of urinary calculi complicated with severe infection after ureteroscopic lithotripsy in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. The gender, age, comorbid diseases, incidence of urinary calculi, results of preoperative urine culture, operation time, length of stay, and numbers of general sepsis and severe sepsis after operation were recorded. Results Among 11 patients with severe infection, there were 7 cases of male and 4 cases of female. The age ranged 39-69 years old, with an average of (49±11)years old; 4 cases had diabetes mellitus, 5 cases had hypertension and 3 cases had cardiac diseases; 4 cases had simple ureteral calculi, 2 cases had simple renal calculi and 5 cases had renal calculi combined with ureteral calculi; 9 cases had unilateral lesions and 2 cases had bilateral lesions. Four cases had positive urine culture before surgery, and were treated with oral anti-infective drugs for 3-7 d. The operation was performed by hard ureteroscope, flexible ureteroscope or the combination of the two. The operation time ranged 35-190 min, with an average of (87±15)min. The length of stay ranged 9-21 d, with an average of (15.1±1.2)d. After operation, there were 8 cases of general sepsis and 3 cases of severe sepsis, and 2 cases of the latter had septic shock. All patients were hospitalized for 5-16 d after the diagnosis. Two cases were transferred to infection department for treatment. All patients recovered and discharged without death. Conclusions  Patients with many comorbid diseases, large calculi burden, long obstruction time and obvious infection symptoms should be alert to the possibility of severe infection after surgery. Full anti-infection drainage before surgery, attention to early clinical signs monitoring during and after surgery, and timely response to treatment are the keys to successful treatment of severe infection after ureteroscopic lithotripsy.