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能否识别逆行性肾内手术中并发症高危患者?一项回顾性风险因素分析。

Can We Identify Patients in Danger of Complications in Retrograde Intrarenal Surgery?-A Retrospective Risk Factors Analysis.

机构信息

Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland.

Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland.

出版信息

Int J Environ Res Public Health. 2022 Jan 20;19(3):1114. doi: 10.3390/ijerph19031114.

DOI:10.3390/ijerph19031114
PMID:35162137
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8834554/
Abstract

Retrograde intrarenal surgery (RIRS) is an innovative and effective method of kidney stones treatment, as it had great influence on the development of endoscopy in urology. The increasing prevalence of urolithiasis together with the rapid development of endourology leads to a rise in the number of procedures related to the disease. Flexible ureteroscopy is constantly being improved, especially regarding the effectiveness and safety of the procedure. The purpose of this study is to evaluate intraoperative and early post-operative complications of RIRS in the treatment of kidney stones. A retrospective analysis of medical records was performed. A series was comprised of 207 consecutive operations performed from 2017 to 2020. Complications occurred in 19.3% ( = 40) of patients. Occurrence according to the Clavien-Dindo scale was: 11.1% for grade I, 5.8% for grade II and 2.4% for grade IV. Infectious complications included SIRS (5.3%, = 11) and sepsis (2.4%, = 5). Statistical analysis revealed a correlation between acute post-operative infections and positive midstream urine culture, history of chronic or recurrent urinary tract infections, and increased body mass index (BMI). Furthermore, a significant correlation was observed between pain requiring the use of opioids with BMI over 25. Consequently, history of urinary tract infections, positive pre-operative urine culture, and increased BMI are considered risk factors and require appropriate management.

摘要

逆行性肾内手术 (RIRS) 是一种创新性且有效的肾结石治疗方法,因为它对泌尿科内镜的发展产生了重大影响。随着尿石症发病率的增加和腔内泌尿外科的快速发展,与该疾病相关的手术数量也在增加。软性输尿管镜不断得到改进,尤其是在手术的有效性和安全性方面。本研究旨在评估 RIRS 治疗肾结石的术中及早期术后并发症。对病历进行了回顾性分析。该系列包括 2017 年至 2020 年连续进行的 207 例手术。19.3%(=40)的患者发生了并发症。根据 Clavien-Dindo 分级,发生:I 级 11.1%,II 级 5.8%,IV 级 2.4%。感染性并发症包括全身炎症反应综合征 (SIRS,5.3%,=11) 和败血症 (2.4%,=5)。统计分析显示,术后急性感染与中段尿培养阳性、慢性或复发性尿路感染史和体重指数 (BMI) 增加之间存在相关性。此外,疼痛需要使用阿片类药物与 BMI 超过 25 之间也存在显著相关性。因此,尿路感染史、术前尿培养阳性和 BMI 增加被认为是危险因素,需要进行适当的管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f3f/8834554/9ae0ace5164a/ijerph-19-01114-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f3f/8834554/9ae0ace5164a/ijerph-19-01114-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f3f/8834554/9ae0ace5164a/ijerph-19-01114-g001.jpg

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本文引用的文献

1
The Urosepsis-A Literature Review.尿路脓毒症——文献综述。
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Urinary tract infection in women.女性尿路感染
Prz Menopauzalny. 2021 Apr;20(1):40-47. doi: 10.5114/pm.2021.105382. Epub 2021 Apr 21.
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Intraoperative and postoperative surgical complications after ureteroscopy, retrograde intrarenal surgery, and percutaneous nephrolithotomy: a systematic review.经输尿管镜检查术、逆行性肾内手术和经皮肾镜取石术治疗后的术中及术后手术并发症:系统评价。
预测逆行性肾内手术后术前尿培养阴性患者发热危险因素的列线图。
World J Urol. 2023 Mar;41(3):783-789. doi: 10.1007/s00345-023-04302-5. Epub 2023 Feb 11.
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Can We Identify Patients in Danger of Delayed Treatment? Management of COVID-19 Pandemic Backlog in Urology Care in Poland.能否识别可能延迟治疗的患者?波兰泌尿科 COVID-19 积压病例管理。
Int J Environ Res Public Health. 2022 Dec 9;19(24):16547. doi: 10.3390/ijerph192416547.
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Risk of Sepsis in Retrograde Intrarenal Surgery: A Systematic Review of the Literature.逆行性肾内手术中脓毒症的风险:文献系统综述
Eur Urol Open Sci. 2022 Aug 30;44:84-91. doi: 10.1016/j.euros.2022.08.008. eCollection 2022 Oct.
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Retropulsion force in laser lithotripsy-an in vitro study comparing a Holmium device to a novel pulsed solid-state Thulium laser.激光碎石术中的后冲力——体外比较钬设备与新型脉冲固态铥激光的研究。
World J Urol. 2021 Sep;39(9):3651-3656. doi: 10.1007/s00345-021-03668-8. Epub 2021 Mar 23.
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