CAJ | 학술논문

目的：评价输尿管软镜碎石取石术治疗肾结石伴难治性尿路感染的疗效和安全性。方法回顾分析2011年10月至2014年6月15例感染性肾结石应用输尿管软镜下钬激光碎石取石治疗的临床资料，与同期行输尿管软镜手术且无明显尿路感染患者进行对照。感染组15例患者术前均有尿路感染及发热症状，术前根据尿培养选用敏感抗生素治疗2周，尿中白细胞仍维持在100个／μL以上。手术使用Storz Flex‐X2 F7．5输尿管软镜进行碎石取石术，钬激光功率设置为0．8～1．0 J ／5～10 Hz ，术中留置F6双J管。术后观察体温变化、血常规及KUB。术后2周复查尿常规及尿路CT 平扫，评估尿路感染控制情况及排石效果。术后2～4周拔除双J管。结果所有患者均一次碎石成功。术中发现感染组15例患者肾盂内尿液浑浊、伴有絮状物，其中有2例结石被脓苔样组织包裹。术中用钬激光碎石，用套石篮取出碎石，取净脓苔样组织，平均手术时间（30±21）（15～50） min ，术后结石清除率为93．3％（14／15）；有2例（13．3％）出现术后发热，均在术后6 h内发生，最高体温在39℃以下，抗炎对症治疗后好转。结论敏感抗生素保护下行输尿管软镜碎石取石术是治疗感染性肾结石的安全有效的方法，其结石清除率高、并发症低，但术中需低压冲洗，且术后仍有出现发热的风险，需要密切关注。
목적：평개수뇨관연경쇄석취석술치료신결석반난치성뇨로감염적료효화안전성。방법회고분석2011년10월지2014년6월15례감염성신결석응용수뇨관연경하화격광쇄석취석치료적림상자료，여동기행수뇨관연경수술차무명현뇨로감염환자진행대조。감염조15례환자술전균유뇨로감염급발열증상，술전근거뇨배양선용민감항생소치료2주，뇨중백세포잉유지재100개／μL이상。수술사용Storz Flex‐X2 F7．5수뇨관연경진행쇄석취석술，화격광공솔설치위0．8～1．0 J ／5～10 Hz ，술중류치F6쌍J관。술후관찰체온변화、혈상규급KUB。술후2주복사뇨상규급뇨로CT 평소，평고뇨로감염공제정황급배석효과。술후2～4주발제쌍J관。결과소유환자균일차쇄석성공。술중발현감염조15례환자신우내뇨액혼탁、반유서상물，기중유2례결석피농태양조직포과。술중용화격광쇄석，용투석람취출쇄석，취정농태양조직，평균수술시간（30±21）（15～50） min ，술후결석청제솔위93．3％（14／15）；유2례（13．3％）출현술후발열，균재술후6 h내발생，최고체온재39℃이하，항염대증치료후호전。결론민감항생소보호하행수뇨관연경쇄석취석술시치료감염성신결석적안전유효적방법，기결석청제솔고、병발증저，단술중수저압충세，차술후잉유출현발열적풍험，수요밀절관주。
ABSTRACT:Objective To study the efficacy and safety of flexible ureteroscopic lithotripsy for renal stones complicated with recurrent urinary tract infection (UTI) .Methods Clinical data of 15 patients with renal stones and recurrent UTI (UTI group) were retrospectively reviewed .The patients were treated with flexible ureteroscopic lithotripsy during Oct .2011 to June 2014 .A group of 15 patients with renal stones but without any sign of UTI were included as controls .All patients in the UTI group presented urinary tract stimulus symptoms and fever .Antibiotics were given according to mid‐stream urine culture for two weeks .But routine urine test still showed white blood cell (WBC) >100/μL .Storz Flex‐X2 F7 .5 ureteroscope was stand‐ard equipment for the operation .Holium laser was set as 0 .8~1 .0 J /5~10 Hz .A F6 double J stent was inserted after the op‐eration .Vital signs ,routine blood test and KUB were observed as well .Two weeks after operation ,a routine urine test and non‐contrast CT scan were performed to evaluate UTI and stone free rate (SFR) .The double J stent was removed 2‐4 weeks after the operation .Results All operations were done in one‐stage .In the UTI group ,all cases had urinary cloudiness and two of them had pus covered the stones .All stones and pus were cleared in the surgery .The average operation time was (30 ± 21)min (15~50 min) .The stone free rate was 93 .3% (14/15) .Fever was observed in 2 (13 .3% ) cases within 6 hours after operation ,and the highest temperature was 39 ℃ .All patients were cured with antibiotics .Conclusions It's safe to perform flexible ureteroscopic lithotripsy on renal stone patients with recurrent UTI under the protection of sensitive antibiotics .The SFR and post‐operative complications were acceptable .Low‐pressure irrigation and careful post‐operative observation are of great importance for these patients .