关键词: 输尿管梗阻；尿源性脓毒血症, 经皮肾造瘘术；血小板减少

Abstract: Objective To investigate the safety and effectiveness of percutaneous nephrostomy in the treatment of obstructive urinogenic sepsis complicated with thrombocytopenia.Methods  Clinical data of 116 patients with urogenic sepsis complicated with thrombocytopenia admitted to Xiaogan Hospital of Wuhan University of Science and Technology from October 2017 to May 2021 were collected.There were 23 patients with abnormal renal function indexes (serum creatinine >500mmol/ L).Preoperative urinary tract CT or ultrasound were performed to confirm hydronephrosis. According to the number of platelets in preoperative blood routine,they were divided into study group (platelet <50×10⁹/L) and control group (platelet ≥50×10⁹/L).Percutaneous nephrostomy was performed under ultrasound guidance in both groups.The outcome indexes included the success rate of operation,body temperature,routine white blood cell count,the time to return to normal of procalcitonin,postoperative bleeding,shock,and side injury.Results In the study group, preoperative fever time was (6.9±2.2) days, platelet count was (35±10.2)×109/L, preoperative procalcitonin (PCT) was (36±6.2)ng/ml, and serum creatinine increased by 30%. While, the data in control group were (4.2 + 2.0) days,(115±58.9)×10⁹/L, (20±2.6)ng/ml and 12%,respectively.The difference between the two groups was statistically significant(P<0.05).The recovery time of PCT in study group and control group was (6.9±2.8) days and (4.8±1.5) days, respectively. The normal recovery time of body temperature was (36.2±3.5) hours and (28.5±2.3) hours, respectively. The recovery time of white blood cell count was (5.3 ±1.2) days and (3.2±2.5) days, respectively. The recovery time of platelet was (6.0 ±2.3) days and (3.5±2.0) days, respectively. The difference between the two groups was statistically significant(P<0.05).There was no significant difference in surgical success rate, postoperative collateral injury, massive hemorrhage, shock and other complications between the two groups (P>0.05).Conclusion Percutaneous nephrostomy (PCN) is effective and safe in the treatment of urogenic sepsis with thrombocytopenia,and it is worth popularizing. 

Key words: ureteral obstruction, urinary sepsis, percutaneous nephrostomy, thrombocytopenia