优化尿石症和梗阻性尿病患者上尿路引流后的碎石时间

A. I. Khotko, D. N. Khotko, V. Popkov, A. I. Tarasenk
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The level of inflammatory markers (IL-8) and profibrotic factor (MCP-1) in the urine was determined. The calculated concentrations of urinary biomarkers were normalized by the level of urinary creatinine. Urine sampling for the analysis was carried out during and after the PCN placement (nephrostomy urine) 7 days later, and then once weekly before surgery. The coefficient K was calculated using a patented formula to evaluate the process of kidney remodeling. Urine sampling was performed for culture to determine the bacterial spectrum and antibiotic sensitivity.Results. The values of K ≤ 1.85 were observed in 11 patients of the group with OU (12.2%), K > 1.85 in 79 (87.8%) by day 21. The values of K ≤ 1.85 were achieved in 70 patients (88.6%) by day 28 and 4 patients (80.0%) by day 35. 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引用次数: 0

摘要

介绍。感染患者及时解决的上尿路梗阻可引起严重的并发症,如脓毒症、脓肾甚至死亡。关于引流的方法和时间没有明确的建议。与此同时,这个问题仍然是近年来出版物讨论的主题。研究目的:目的:优化尿石症合并梗阻性尿病(OU)患者UUT引流后的碎石时间。材料和方法。在第一阶段,90例由输尿管肾盂连接处结石引起的OU患者采用经皮肾造口术引流UUT。随后在引流后不同时间行经皮肾镜碎石术(PNLT)。测定尿中炎症标志物(IL-8)和促纤维化因子(MCP-1)水平。尿液生物标志物的计算浓度通过尿肌酐水平归一化。在PCN放置(肾造口尿)7天后进行尿液取样分析,然后在手术前每周取样一次。使用专利公式计算系数K,以评估肾脏重塑过程。尿样进行培养,以确定细菌谱和抗生素敏感性。合并OU组11例(12.2%)患者K≤1.85,79例(87.8%)患者K≤1.85。70例患者(88.6%)在第28天达到K≤1.85,4例患者(80.0%)在第35天达到K≤1.85。K≤1.85的患者(11例)于21天行PNLT,术后无并发症发生。K≤1.85的患者(70例)在第28天行PNLT,未发现肾盂肾炎加重和慢性肾脏疾病的发展。6例K值为1.85的患者于第28天行PNLT。术后所有患者结石性肾盂肾炎均有加重,50%患者术后3个月内肾小球滤过率下降。尿中检出细菌55例(61.0%)。以大肠杆菌(63.0%)、奇异变形杆菌(18.0%)、粪肠球菌(14.5%)、溶血链球菌(2.5%)检出最多。使用开发的重塑指数可以优化手术时机,并最大限度地减少术后并发症的发生。细菌的存在与肾实质重塑的漫长过程有关。
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Optimizing the lithotripsy timing after drainage of the upper urinary tract in patients with urolithiasis and obstructive uropathy
Introduction. Timely unresolved upper urinary tract (UUT) obstruction in patients with infection can cause severe complications, such as sepsis, pyonephrosis and even death. There are no clear recommendations regarding the methods and timing of drainage. At the same time, this issue is still the subject of discussion in publications of recent years.Purpose of the study. To optimize the timing of lithotripsy after drainage of the UUT in patients with urolithiasis and obstructive uropathy (OU).Materials and methods. At the first stage, 90 patients with OU caused by the stone of the ureteropelvic junction underwent drainage of the UUT using a percutaneous nephrostomy. Subsequently, percutaneous nephrolithotripsy (PNLT) was performed at various times after drainage. The level of inflammatory markers (IL-8) and profibrotic factor (MCP-1) in the urine was determined. The calculated concentrations of urinary biomarkers were normalized by the level of urinary creatinine. Urine sampling for the analysis was carried out during and after the PCN placement (nephrostomy urine) 7 days later, and then once weekly before surgery. The coefficient K was calculated using a patented formula to evaluate the process of kidney remodeling. Urine sampling was performed for culture to determine the bacterial spectrum and antibiotic sensitivity.Results. The values of K ≤ 1.85 were observed in 11 patients of the group with OU (12.2%), K > 1.85 in 79 (87.8%) by day 21. The values of K ≤ 1.85 were achieved in 70 patients (88.6%) by day 28 and 4 patients (80.0%) by day 35. PNLT was performed on 21 days in patients with K ≤ 1.85 (11 patients), no complications were noted in the postoperative period., PNLT was performed in patients with K ≤ 1.85 (70 patients) by day 28, exacerbation of pyelonephritis and the development of chronic kidney disease were not noted. Six patients with values of K ˃ 1.85 underwent PNLT by day 28. In the postoperative period, all patients had an exacerbation of calculous pyelonephritis, 50% had a decrease in glomerular filtration rate within 3 months after surgery. The bacteria in urine were detected in 55 (61.0%) patients. Escherichia coli (63.0%), Proteus mirabilis (18.0%), Enterococcus faecalis (14.5%), Streptococcus haemolyticus (2.5%) were identified most often.Conclusion. The use of the developed remodeling index allows optimizing the surgery timing and minimizing the development of complications during the postoperative period. The presence of bacteria is associated with a long process of renal parenchymal remodeling.
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