Jou Yeong-Chin, Lu Chin-Li, Chen Fang-Hung, Shen Cheng-Huang, Cheng Ming-Chin, Lin Shu-Hua, Chuang Shu-Chiung, Li Yun-Hsuan
Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan; Department of Public Health, College of Medical School, National Cheng-Kung University, Tainan, Taiwan.
Urology. 2015 Mar;85(3):527-30. doi: 10.1016/j.urology.2014.10.032. Epub 2014 Nov 1.
To evaluate the contributing factors for fever after tubeless percutaneous nephrolithotomy (PCNL).
Between May 2009 and December 2013, 395 tubeless PCNLs were performed at our hospital. After stone extraction, the bleeding points were cauterized for hemostasis to enable tubeless modification. In patients with troublesome bleeding after cauterization, oxidized regenerated cellulose (Surgicel) strips were used to tamponade the access tract to facilitate bleeding control. The contributory factors for fever were evaluated by a retrospective chart review.
Forty-four patients (11.7%) developed fever after tubeless PCNL. There was no difference in gender, age, and body mass index in the development of fever. Episodes of febrile or septic urinary tract infection before PCNL were found to have occurred in 35 patients, but the incidence of postoperative fever was not significantly higher in these patients. There is no significant difference in the mean stone size in fever and nonfever patients. Complete staghorn stones were noted in 40 patients, and their fever rate was not significantly higher than patients with nonstaghorn stone. The operation time is not significantly higher in the group with urinary tract infection. Patients with postoperative fever had a high incidence of residual stones than the remaining patients (38.9% vs 20.4%). There was no significant difference in incidence of postoperative fever in patients with struvite stones than patients with nonstruvite stones. In patients who received Surgicel packing, the incidence of fever was not significantly higher.
Incomplete stone extraction is a major contributing factor for the development of fever after tubeless PCNL.
评估无管经皮肾镜取石术（PCNL）后发热的相关因素。
2009年5月至2013年12月，我院共进行了395例无管PCNL手术。结石取出后，对出血点进行烧灼止血以实现无管化改良。对于烧灼后出血难以控制的患者，使用氧化再生纤维素（速即纱）条填塞穿刺通道以促进出血控制。通过回顾性病历审查评估发热的相关因素。
44例患者（11.7%）在无管PCNL术后出现发热。发热的发生在性别、年龄和体重指数方面无差异。术前有发热或脓毒性尿路感染发作的患者有35例，但这些患者术后发热的发生率并未显著更高。发热患者和未发热患者的平均结石大小无显著差异。40例患者有完全鹿角形结石，其发热率并不显著高于非鹿角形结石患者。尿路感染组的手术时间并无显著更长。术后发热患者的残余结石发生率高于其余患者（38.9%对20.4%）。鸟粪石结石患者的术后发热发生率与非鸟粪石结石患者相比无显著差异。接受速即纱填塞的患者发热发生率并未显著更高。
结石清除不完全是无管PCNL术后发热的主要相关因素。
