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目的分析经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗曾合并尿脓毒血症的梗阻性尿石症(obstructive urolithiasis with urosepsis initially,OUU)的临床疗效。方法选择2010年1月至2014年12月因肾结石和(或)输尿管上段结石引起尿脓毒血症后解除梗阻后于我院行PCNL的患者作为研究对象,采用1∶1配对分析方法,选择同期因肾结石和(或)输尿管上段结石但未引起尿脓毒血症(obstructive urolithiasis with no urosepsis initially,NOUU)行PCNL的患者作为对照组,比较PCNL治疗两组的疗效和安全性。结果总共纳入172例患者,其中男性122例(71%),女性50例(29%),平均年龄46.2岁(32~65岁)。两组年龄、性别比、体重指数、合并症、结石大小、结石数量和结石位置差异均无统计学意义(P>0.05)。与NOUU组相比,OUU组的结石清除率无明显差异(86.0%vs.84.8%,P=0.829),但术后总并发症发生率明显升高,肾造瘘管留置时间、住院时间和术后抗生素使用时间明显延长,抗生素使用级别明显更高(P值均<0.05)。OUU组的术后发热(11.6%vs.3.5%,P=0.043)、无症状性菌尿(11.6%vs.3.5%,P=0.043)和尿路感染(10.5%vs.2.3%,P=0.029)发生率均高于NOUU组。但两组在术后败血症(2.3%vs.1.2%,P=0.560)发生率方面差异无统计学意义。结论与NOUU相比,OUU患者解除梗阻后行PCNL结石清除率相似,但术后并发症明显升高。
Objective To analyze the clinical efficacy of percutaneous nephrolithotomy (PCNL) in the treatment of obstructive urolithiasis with urosepsis initially (OUU). Methods January 2010 to December 2014 due to kidney stones and / or ureteral stones caused by urinary sepsis urinary sepsis after obstruction in our hospital PCNL patients as the research object, using 1: 1 paired analysis method, To compare the efficacy and safety of patients with PCNL treated with PCNL in patients with kidney stones and / or stones in the upper ureteral calculi during the same period (NOUU) without PCNL. Results A total of 172 patients were enrolled, including 122 males (71%) and 50 females (29%), with an average age of 46.2 years (32-65 years). There were no significant differences in age, sex ratio, body mass index, comorbidities, stone size, number of stones and stone locations between the two groups (P> 0.05). Compared with the NOUU group, there was no significant difference in the stone clearance rate between the OUU group and the NOUU group (86.0% vs.84.8%, P = 0.829), but the incidence of postoperative complications was significantly higher than that of the NOUU group After the antibiotic use was significantly longer, antibiotic use was significantly higher (P values were <0.05). Postoperative fever (11.6% vs.3.5%, P = 0.043), asymptomatic bacteriuria (11.6% vs.3.5%, P = 0.043) and urinary tract infection (10.5% vs.2.3%, P = 0.029) were higher than the NOUU group. However, there was no significant difference in the incidence of postoperative sepsis (2.3% vs.1.2%, P = 0.560). Conclusions Compared with NOUU, the clearance rate of PCNL stone in OUU patients after obstruction was similar, but the postoperative complications were significantly higher.