Abstract: 【Abstract】〓Objective〓To investigate the therapeutic effect of by ureteral stent insertion (internal diversion) or percutaneous nephrostomy (external diversion) in the patients suffered from ureteral calculus complicated with urosepsis. Methods〓From Jan 2011 to Dec 2013,.a total of 63 patients suffered from ureteral calculus complicated with urosepsis were randomized into two groups. In internal diversion group, 31 patients underwent double J ureteral stenting, while in external group,.32 patients underwent percutaneous nephrostomy tube insertion. The double J stent was inserted retrograde by using cystoscope or ureteroscope,.while the percutaneous nephrostomy was done under ultrasound guidance. Results〓The overall success rate of diversion in internal diversion group and external diversion group is 96.8% and 90.6% respectively (P=0.3170). The time of controlling sepsis after the diversion were (4.6±1.9) d and (3.5±1.7) d (P=0.0184). After URL, six patients in the internal diversion group suffered from recurrent urosepsis, and no recurrence of urosepsis in external diversion group (P=0.0287). One patient progressed to septic shock among those 6 patients in the internal diversion group. Conclusion〓Both internal and external diversion appear effective in the patients suffered from ureteral calculus complicated with urosepsis,.but external diversion exists a better approach of temporary urinary diversion than internal diversion for management of ureteral calculus complicated with urosepsis.

Key words: Ureteral calculus, Urosepsis, Percutaneous nephrostomy, Double J stenting

摘要： 【摘要】 目的 探讨对输尿管结石合并尿脓毒血症患者分别行内、外引流的治疗效果。方法 我院2011年1月~2013年12月收治输尿管结石合并尿脓毒血症患者63例,随机分内引流组(31例)和外引流组(32例),内引流组患者行膀胱镜或输尿管镜下双J管置入术,外引流组患者在B超引导下行经皮肾穿刺造瘘术,记录两组患者引流成功率,计算从引流成功至尿脓毒血症得到控制所需时间,记录输尿管镜碎石术后尿脓毒血症复发例数、感染性休克发生例数。结果〓内、外引流组引流成功率分别为96.8%和90.6%,差异无统计学意义(P=0.3170)。两组患者尿脓毒血症所需控制时间分别为4.6±1.9 d和3.5±1.7 d,差异有统计学意义(P=0.0184)。内引流组输尿管镜碎石术后6例再发尿脓毒血症,而外引流组无1例再发,差异有统计学意义(P=0.0287)。内引流组再发脓毒血症患者中有1例出现感染性休克。结论〓输尿管结石合并感染患者,内、外引流方式成功率均较高,但外引流控制感染时间短、输尿管镜碎石术后尿脓毒血症再发率低。

关键词: 输尿管结石, 尿脓毒血症, 双J管置入术, 经皮肾穿刺造瘘术