CAJ | 학술논문

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 164例上尿路结石病人分成5组。A组：48例肾结石病人，结石1-4枚(直径均≤2 cm)。B组：24例肾结石病人，结石1-3枚(直径均＞2 cm)。C组：22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0.5-1.2 cm)。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≤2 cm、对引流系统无明显影响的肾结石或直径0.5-1.2 cm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＞2 cm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可靠、灵敏、简单的方法。
목적탐토체외충격파쇄석(ESWL)도치궤체감염적가능성급측정뇨액내독소적개치화의의。방법 164례상뇨로결석병인분성5조。A조：48례신결석병인，결석1-4매(직경균≤2 cm)。B조：24례신결석병인，결석1-3매(직경균＞2 cm)。C조：22례신결석병인，결석1-3매，반1-2매수뇨관결석。D조：51례수뇨관결석병인，결석1-3매(직경위0.5-1.2 cm)。E조：19례복잡성신결석병인。제A조외균유불동정도뇨류경조。ESWL치료전균무뇨로감염。소유환자ESWL치료전후취혈、뇨작세균배양급이후시험측내독소농도。결과소유병인ESWL치료전、후혈액내독소농도균무현저성변화，혈액세균배양균위음성。B、C화E조ESWL치료후뇨액내독소균교치료전현저성승고。A화D조ESWL치료전후뇨액내독소농도균무현저성개변。ESWL치료후B、C화E조뇨액세균배양양성솔교A화D조현저승고，혹비상현저승고。결론직경≤2 cm、대인류계통무명현영향적신결석혹직경0.5-1.2 cm적수뇨관결석，ESWL치료도치비뇨계감염적가능성교소；단복잡성、직경＞2 cm적신결석、혹신결석반수뇨관결석，즉사ESWL치료전무균뇨증，ESWL도치비뇨계감염적가능성대，예방성사용항생소시필요적。령외，뇨액내독소측정시진단ESWL병인비뇨계시부감염적일개가고、령민、간단적방법。
Objective To clarify the infection risks and the value of endotoxin determination in urine during extracorporeal shock wave lithotripsy (ESWL).Methods According to the distribution and complications of upper urinary calculi, 164 patients were divided into five groups. Group A consisted of 48 patients with 1 to 4 renal calculi, which were or less than 2 crn in diameter. Group B was composed of 24 patients with renal calculus larger than 2 cm in diameter or one to multiple renal calculi. Group C wes composed of 22 patients with 1 to 3 renal calculi accompanied by 1 to 2 ureteric calculi. Group D consisted of 51 patients with 1 to 3 ureteric calculi that were 0.5 to 1.2 cm in diameter, respectively. Group E included 19 patients with complicated renal calculus, such es casting and staghom renal calculus. Urine and blood samples of these patients were obtained before and after ESWL, respectively. Their urine samples were proven sterile prior to treatment. All samples were cultured for bacteria and investigated for endotoxin concentration by the limulus lysate test.Results No significant difference in serum endotoxin wes noted before and after ESWL. Blood bacterial cultures were all negative in all patients after ESWL, similar to those before ESWL. Significant increases in urine endotoxin after ESWL compared with that before ESWL in patients of Groups B, C and E were observed, respectively (P ＜ 0.05). There was no significant difference in urine endotoxin after ESWL compared with that before ESWL in patients of Groups A and D. The positive incidences of urine bacterial culture were significantly increased (P ＜ 0.05) in Groups B and C and very significantly increased ( P ＜ 0.01 ) in Group E compared with those in Groups A and D.Conclusions Urinary infection risk following ESWL was lower in patients with one to several renal calculi,which were less than 2 cm in diameter and did not interfere obviously with the urine flow or in patients with 1 to 3 ureteric calculi that were 0. 5 to 1.2 cm in diameter. The risk was higher in those with complicated calculi, such as casting, staghom renal calculus, renal calculus larger than 2 cm in diameter or renal calculi accompanied by ureteric calculi. For patients with higher infection risk after ESWL, prophylactic antibiotics are necessary even if bacteriuria is not present before ESWL. Endotoxin determination in urine is a reliable,sensitive and simple method for the diagnosis of bacterial infection in patients undergoing ESWL.