輸尿管鏡碎石手術前的經皮腎造廔引流是否能降低術後敗血症的機率？
賴俊佑、蕭博任、黃志平、鄒頡龍、陳汶吉、張兆祥
中國醫藥大學附設醫院 泌尿科部
Does percutaneous nephrostomy (PCN) decrease sepsis rate before ureteroscopic lithotripsy (URSL)?
Chun-Yo Laih, Po-Jen Hsiao, Chi-Ping Huang, Chieh-Lung Chou, Wen-Chi Chen, Chao-Hsiang Chang
Divisions of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose: Sepsis induced from impacted ureteral stones may be lethal. The prior conventional approach advocates the importance of PCN for kidney drainage before the surgery. The aim of this retrospective study is to understand the role of preoperative PCN in relation to postoperative sepsis rate.
Materials and Methods: We conducted a retrospective review of all URSL procedures performed at China Medical University Hospital from from September 1st 2015 to August 31st 2016. The definition of sepsis is based on The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) published August 31th 2016 by the Journal of the American Medical Association (JAMA).
Results: A total of 438 patients underwent URSL during the one year period, though 23 (5.3%) patients were excluded because of preoperative sepsis. Thirty-three (7.5%) patients had preoperative PCN, and of these 33 patients, a total of 6 (18.2%) patients suffered from postoperative sepsis. Three hundred and eighty two (92.5%) patients did not receive preoperative PCN and of those, only 33 (8.6%) patients suffered from postoperative sepsis (p value: 0.071). The data collected for analysis included patient age, gender, days of hospital stay, stone burden, type of anesthesia, days of ureteral stenting, preoperative and postoperative Sequential Organ Failure Assessment score (qSOFA score, SOFA score), underlying disease, and pubic depilation status..
Conclusions: PCN is the standard therapeutic procedure preceding URSL for impacted ureteral stones to prevent postoperative sepsis. However, this paper advocates perform URSL directly in selected clinical situations by skilled urologists may be feasible.