| Objective:Analyze and summarize the clinical characteristics of urogenital sepsis,the common causes of postoperative sepsis in urinary tract,summary of the reasons for delayed treatment,different phases and different methods of surgical drainage for urinary obstruction The impact of urinary sepsis on prognosis.Methods:The clinical data of 70 patients with urinary sepsis admitted to our hospital from January 2013 to October 2017 were retrospectively analyzed,including age,gender,cause of etiology,related laboratory indicators,treatment methods,and treatment.Time and prognosis.Statistical methods:The index was statistically analyzed using SPSS 22 software.The normal distribution of measurement data was?X±S.The effect of surgical drainage on the prognosis and treatment time at different time points was tested using Tamhane's non-parametric tests.Independent t-tests were used for comparison.Count data were analyzed using?~2 test or Fisher's test.p<0.05was considered statistically significant.Results:(1)Among 17 cases of postoperative urogenital sepsis,14 cases(82.3%)were treated with percutaneous nephrolithotomy.One of them was treated with second-stage percutaneous nephrolithotomy(without indwelling drainage tube).3cases(17.7%)had ureteral lithotripsy;11 patients(64.7%)had preoperative infection,mean stone diameter 2.4±0.7cm,mean operation time 103.8±24.3min,and2 cases had delayed resuscitation of surgical anesthesia.One case had poor drainage and 9 cases suffered from septic shock.All 17 cases were diagnosed in a timely manner.Anti-infective,fluid resuscitation was performed.One patient had poor surgical drainage after adjusting the position of the double J tube and symptomatic treatment of complications.An average of 3.7±1.3 days improved after treatment.(2)53 cases of urinary sepsis caused by urinary obstruction,of which 25 cases in the early stage of the disease,only acute renal failure,no other active dysfunction of other organs when active drainage,no one case of septic shock The average duration of treatment was 3.3±0.4 days.19 cases were not treated effectively in the early stage and all patients had multiple organ dysfunctions.Surgical drainage was performed in9 cases,of which septic shock occurred.The average treatment time was 5.1±1.7 days.Surgical drainage resulted in multiple organ failures.Seven patients developed septic shock and one died.The average treatment time was 8.4±2.2 days.There was a significant difference in treatment time(p<0.05).Of the 22 patients with thrombocytopenia,16 underwent surgical drainage after conservative treatment was not significantly improved,and the platelet changes preoperatively and postoperatively.(3)Thirty-four cases were transferred from the external hospital,all of which were transferred from internal-level cities and county-level hospitals in Jiangxi Province.The hospitals consisted of two grade A hospitals(5.9%),two grade B hospitals(2.9%),and two hospitals.Grade A hospitals(64.7%),tertiary hospitals(5.8%),and tertiary hospitals(20.7%).(4)orty-four patients underwent surgical ureteroscopic ureteral stenting in 30 cases,including 28 double-J tubes,of which 3were treated with a single J tube followed by a double-J tube during the operation.One case was placed on the same side with single J tube and double J tube,and one case with single J tube was placed.Percutaneous nephrostomy was performed in 14cases.Blood WBC,CRP,PCT,Scr were performed within 48 hours after operation in2 operations.There was no significant difference in the change values(p>0.05).The success rate of ureteral stenting was 96.6%.There was one case in which the ureter was extremely distorted and the catheter failed to change after percutaneous nephrostomy.Percutaneous nephrostomy was performed.The success rate was 100%.There was no significant difference between the two groups(p>0.05).There was one bleeding complication after percutaneous nephrostomy(7.1%).No significant complications occurred after ureteroscopic stent placement.There was no significant difference between the two groups(p>0.05).There was no significant difference in sepsis control time(3.9±1.6 VS 3.6±1.4)between the two groups(p>0.05).Conclusions:(1)For postoperative urinary sepsis,it is often related to surgical methods,uncontrolled preoperative infections,the complexity of stones,long operation time,delayed resuscitation of anesthesia,and unobstructed drainage.(2)Clinical urinary sepsis progresses rapidly.Early diagnosis and treatment can improve the prognosis of patients.However,clinically,some patients are often difficult to achieve early and timely treatment,often lack of attention to the disease and lack of medical knowledge.The unequal distribution of medical resources,the limited level of primary medical care,and the reimbursement of medical insurance in other places are related to factors that make patients miss the best treatment time,which greatly affects the prognosis of patients.(3)Ureteroscopic ureteral stenting and percutaneous nephrolithotomy,both surgical methods are relatively safe and effective,clinically based on different patients and the doctor's proficiency in the choice of different surgical methods.(4)For patients with urinary tract obstruction,even with complications such as shock and thrombocytopenia,active anti-shock and other symptomatic treatment should be performed simultaneously with active surgical drainage,which can improve patient prognosis,shorten hospital stay,and reduce mortality. |
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