Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan 430030, China.
Biomed Res Int. 2020 Jan 2;2020:1354672. doi: 10.1155/2020/1354672. eCollection 2020.
The purpose of this study was to assess risk factors of urosepsis after minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of upper urinary tract stones in patients with preoperative urinary tract infection (UTI) and to explore preventive measures. Between 2008 and 2016, patients with preoperative UTI who underwent MPCNL for upper urinary tract stones were retrospectively collected. Patients were divided into nonurosepsis and urosepsis groups. Perioperative outcomes of all patients were evaluated and compared between the two groups. Risk factors for post-MPCNL urosepsis were investigated using univariate and multivariate regression analysis. A total of 843 patients including 22 patients with postoperative urosepsis (urosepsis group) and 821 patients without urosepsis (nonurosepsis group) were finally included in this study. All patients with postoperative urosepsis were cured and discharged after treatment. In univariate analysis it was demonstrated that the incidence of urosepsis after MPCNL was significantly correlated with channel size (=0.001), surgical time (=0.003), as well as the tear of the collection system and percutaneous renal channel crossing the renal papilla (=0.004). Moreover, multivariate analysis showed that smaller channel size (OR = 11.192, 95% CI: 2.425-51.650, =0.002), longer surgical time (OR = 6.762, 95% CI: 1.712-17.844, =0.008), and tear of collection system and percutaneous renal channel crossing the renal papilla (OR = 5.531, 95% CI 1.228-14.469, =0.012) were independent risk factors for urosepsis following MPCNL in patients with preoperative UTI. In conclusion, in patients with preoperative UTI undergoing MPCNL for upper urinary tract stones, smaller channel size, prolonged operation time, as well as tear of the collection system and percutaneous renal channel crossing the renal papilla are independent risk factors for postoperative urosepsis. Therefore, it is indicated that, in clinical practice, it is of great significance to choose appropriate channel size and avoid renal injury and control surgical time to prevent the urosepsis after MPCNL in patients with preoperative UTI.
本研究旨在评估术前尿路感染（UTI）患者接受微创经皮肾镜取石术（MPCNL）治疗上尿路结石后发生尿脓毒症的危险因素，并探讨预防措施。2008 年至 2016 年，回顾性收集了术前 UTI 患者行 MPCNL 治疗上尿路结石的病例。将患者分为非尿脓毒症组和尿脓毒症组。比较两组患者的围手术期结果。采用单因素和多因素回归分析探讨 MPCNL 术后尿脓毒症的危险因素。共纳入 843 例患者，其中术后发生尿脓毒症 22 例（尿脓毒症组），无尿脓毒症 821 例（非尿脓毒症组）。所有术后尿脓毒症患者经治疗后痊愈出院。单因素分析结果显示，MPCNL 术后尿脓毒症的发生率与通道大小（=0.001）、手术时间（=0.003）以及集尿系统撕裂和经皮肾通道穿过肾乳头（=0.004）显著相关。多因素分析显示，较小的通道大小（OR=11.192，95%CI：2.425-51.650，=0.002）、较长的手术时间（OR=6.762，95%CI：1.712-17.844，=0.008）以及集尿系统撕裂和经皮肾通道穿过肾乳头（OR=5.531，95%CI 1.228-14.469，=0.012）是术前 UTI 患者 MPCNL 术后尿脓毒症的独立危险因素。结论：对于术前 UTI 行 MPCNL 治疗上尿路结石的患者，较小的通道大小、较长的手术时间以及集尿系统撕裂和经皮肾通道穿过肾乳头是术后尿脓毒症的独立危险因素。因此，在临床实践中，选择合适的通道大小，避免肾损伤，控制手术时间，对预防术前 UTI 患者 MPCNL 术后尿脓毒症具有重要意义。
