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机器人辅助根治性膀胱切除术后尿路感染的详细分析。

Detailed Analysis of Urinary Tract Infections After Robot-Assisted Radical Cystectomy.

机构信息

Urology Department and Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.

Internal Medicine Department, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.

出版信息

J Endourol. 2021 Jan;35(1):62-70. doi: 10.1089/end.2020.0316. Epub 2020 Nov 6.

Abstract

To describe urinary tract infections (UTIs) after robot-assisted radical cystectomy (RARC) and investigate the variables associated with it. A retrospective review of 616 patients who underwent RARC between 2005 and 2019 was performed. Patients were divided into those who developed UTI and those who did not. Patients who developed UTI were further subdivided into three subgroups according to the onset, number, and severity. The Kaplan-Meier method was used to depict time to UTI. Multivariate analysis was used to investigate variables associated with UTI. Two hundred forty (39%) patients were diagnosed with UTI after RARC; 48% occurred within 30 days, 17% within 30-90 days, and 35% at 90 days after RARC. Twenty-three percent of the patients presented with urosepsis. The median (interquartile ratio) time to develop UTI was 1 (0.3-7) month. On multivariate analysis, patients who received neobladders (odds ratio [OR] 2.80; 95% confidence interval [CI] 1.50-5.20;  < 0.01), prolonged hospital stay (OR 1.06; 95% CI 1.03-1.08;  < 0.01), adjuvant chemotherapy (OR 2.20; 95% CI 1.40-3.60;  < 0.01), poor renal function postoperatively (OR 2.30; 95% CI 1.30-3.80;  < 0.01), postoperative hydronephrosis (OR 2.50; 95% CI 1.40-4.50;  < 0.01), ureteroileal anastomotic stricture (OR 2.90; 95% CI 1.50-5.70;  < 0.01), and stented ureteroileal anastomosis (OR 9.35; 95% CI 1.23-71.19;  = 0.03) were associated with UTI after RARC. UTI is common after RARC mainly within the first month after RARC. was the most common causative organism.

摘要

描述机器人辅助根治性膀胱切除术(RARC)后尿路感染(UTI)的情况,并探讨与之相关的变量。对 2005 年至 2019 年间接受 RARC 的 616 例患者进行回顾性分析。将患者分为发生 UTI 组和未发生 UTI 组。根据发病时间、数量和严重程度,将发生 UTI 的患者进一步分为三组。采用 Kaplan-Meier 法描绘 UTI 发生时间。采用多变量分析探讨与 UTI 相关的变量。

RARC 后 240(39%)例患者诊断为 UTI;48%发生在 30 天内,17%发生在 30-90 天,35%发生在 90 天后。23%的患者出现尿脓毒症。发生 UTI 的中位(四分位距)时间为 1(0.3-7)个月。多变量分析显示,接受新膀胱(优势比[OR]2.80;95%置信区间[CI]1.50-5.20; < 0.01)、延长住院时间(OR 1.06;95%CI 1.03-1.08; < 0.01)、辅助化疗(OR 2.20;95%CI 1.40-3.60; < 0.01)、术后肾功能差(OR 2.30;95%CI 1.30-3.80; < 0.01)、术后肾盂积水(OR 2.50;95%CI 1.40-4.50; < 0.01)、输尿管-回肠吻合口狭窄(OR 2.90;95%CI 1.50-5.70; < 0.01)和留置输尿管-回肠吻合支架(OR 9.35;95%CI 1.23-71.19; = 0.03)与 RARC 后 UTI 相关。

RARC 后 UTI 很常见,主要发生在 RARC 后第一个月内。大肠埃希菌是最常见的病原体。

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