目的 探讨无管化微创PCNL（经皮肾镜取石术）治疗嵌顿性输尿管上段结石的效果。方法 将中山大学附属第一医院惠亚医院2019年12月—2021年12月收治的95例嵌顿性输尿管上段结石患者按照随机数字表法分组,给予对照组47例患者经尿道输尿管镜碎石术（TURL）治疗、观察组48例患者无管化微创PCNL治疗,观察两组手术一般状况、血清学指标、肾脏血流动力学以及并发症发生情况。结果 观察组手术时间、术后血尿以及住院时间均短于对照组,观察组术中出血量少于对照组,观察组结石清除率高于对照组（P<0.05）;术后1 d观察组肾损伤分子-1（KIM-1）、中性粒细胞明胶相关脂脂质运载蛋白（NGAL）以及胱抑素C（Cys-C）水平低于对照组（P<0.05）;两组肾动脉收缩期血流速度（V_s）以及舒张末期血流速度（V_d）对比差异无统计学意义（P>0.05）;观察组并发症发生率（4.16%）低于对照组（19.15%）（P<0.05）。结论 无管化微创PCNL可改善嵌顿性输尿管上段结石手术一般状况,减轻患者肾脏损伤,提高结石清除率,不影响肾脏血流,且并发症更少。

Objective To explore the effect of tubeless minimally invasive（percutaneous nephrolithotomy,PCNL）in the treatment of impacted upper ureteral stones．Methods A total of 95 patients with impacted upper ureteral stones admitted to our hospital from December 2019 to December 2021 were grouped according to the random number table method．Control group of 47 cases were treated with transurethral ureteroscopy lithotripsy（TURL）,48 patients in the observation group were given tubeless minimally invasive PCNL treatment．The general surgical conditions,serological indicators,renal hemodynamics and complications of the two groups were observed．Results The operation time,postoperative hematuria and hospitalization time of the observation group were shorter than those of the control group,the intraoperative bleeding volume of the observation group was less than that of the control group,and the stone free rate of the observation group was higher than that of the control group（P<0.05）．One day after surgery,the levels of kidney injury molecule-1（KIM-1）,lipocalin（NGAL）and cystatin C（Cys-C）in the observation group were lower than those in the control group（P<0.05）;the renal artery systolic blood flow velocity（V_s）and end-diastolic blood flow velocity（V_d）had no statistical significance（P>0.05）;the incidence of complications in the observation group（4.16%）was lower than that in the control group（19.15%）（P<0.05）．Conclusions Tubeless minimally invasive PCNL can improve the general conditions of surgery,reduce kidney damage,increase stone free rate,does not affect renal blood flow,and has fewer complications．

目的 探讨清洁手术在围手术期间所出现的抗菌药物不合理现象的危险因素,提出应对措施。方法 选用我院普外科收治的四种清洁手术(骨折内固定取出手术、乳腺手术、甲状腺手术和疝气手术)患者460例,对所有患者在围手术期间抗菌药物的应用情况进行研究,并对其不合理使用危险因素进行多因素logistic回归分析。结果 患者在清洁手术中抗菌药物的应用率为100%,其中头孢菌素类药物的使用率最高,喹诺酮类药物次之,四种清洁手术的术后用药时间均>7天。对患者资料进行多因素logistic回归分析结果显示,围手术期抗菌药物的不合理使用危险因素主要包括无指征预防使用抗菌药物、给药时间不当、术后用药时间过长、药物选用不合理等七种危险因素(P<0.05)。结论 当前清洁手术的围手术期中,存在着抗菌药物不合理使用的情况,临床诊治过程中应强化科学应用意识和合理化使用观念,确保医药资源的充分利用。