経皮的腎砕石術(PNL)および経尿道的尿管砕石術(TUL)にみられる発熱について

Abstract

PNL 100例およびTUL 50例における発熱についてその要因を検討した.1) PNLでは発熱は尿道感染のある例で有意に高く, また多くみられた.抗生剤の術前投与は発熱例をやや少なくするが, 発熱程度には差がみられなかった.また, 処置回数の多い例に発熱例がやや多くみられたものの, 特に有意差を認めなかった.2) TULでは感染群で高いものの, 特に差を認めず, 抗生剤の術前投与でも発熱を抑制できなかった.しかし, 術後のsingle J-catheterの留置は発熱程度を抑え, 発熱例を少なくした.3)結石の成分ではstruvite結石で発熱例が多く, 蓚酸結石でも発熱例がみられた.4)尿路感染の菌種では術前はProteus, Pseudomonasが多くみられ, 術後はPseudomonas, 真菌が多くみられた.5)発熱の要因は尿路感染, 腎盂内圧が最も大きな要因と考えられ, 尿路感染の治療, 予防は特に重要で, また腎瘻カテーテルの管理にも注意を配るべきである

We studied the fever attacks and their factors in the cases of percutaneous nephrolithotomy (PNL) and transurethral ureterolithotripsy (TUL). In PNL, fevers were significantly higher and more frequent in the cases with infected urinary stones than those with sterile stones, but prophylactic administration of antibiotics did not lower the fever or its frequency of attack. There was no significant difference between the cases of single procedure and those of multiple procedures although multiple procedures were likely to increase the frequency of fever attacks. In TUL, single J-catheter indwelling decreased fever attacks, but infection and administration of antibiotics did not affect the fever significantly. However, careful control of urinary tract infections before and after operation and of intrarenal pressure during operation are thought to be most important for prevention of fever attacks and urosepsis.