Puia Dragoş, Gheorghincă Ştefan, Radavoi George Daniel, Jinga Viorel, Pricop Cătălin
Department of Urology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania.
Department of Urology, C. I. Parhon Hospital, 700503 Iași, Romania.
Exp Ther Med. 2023 Jan 25;25(3):110. doi: 10.3892/etm.2023.11809. eCollection 2023 Mar.
With the increase in percutaneous interventions such as percutaneous nephrolithotomy (PCNL) for renal lithiasis, infectious complications are becoming more frequent. The present study performed a systematic Medline and Embase databases search, using the following words: 'PCNL' [MeSH Terms] AND ['sepsis' (All Fields) OR 'PCNL' (All Fields)] AND ['septic shock' (All Fields)] AND ['urosepsis' (MeSH Terms) OR 'Systemic inflammatory response syndrome (SIRS)' (All Fields)]. Because of the technological advances in endourology, articles published between 2012 and 2022 were searched. Of the 1,403 results of the search, only 18 articles, representing 7,507 patients in which PCNL was performed, met the criteria to be included in the analysis. All authors applied antibiotic prophylaxis to all patients and, in some cases, the infection was treated preoperatively in those with positive urine cultures. According to the analysis of the present study, the operative time has been significantly longer in patients who developed SIRS/sepsis post-operatively (P=0.0001) with the highest heterogeneity (I=91%) compared with other factors. Patients with a positive preoperative urine culture had a significantly higher risk of developing SIRS/sepsis following PCNL (P=0.00001), OD=2.92 (1.82, 4.68) and there was also a high degree of heterogeneity (I=80%). Performing a multi-tract PCNL also increased the incidence of postoperative SIRS/sepsis (P=0.00001), OD=2.64 (1.78, 3.93) and the heterogeneity was a little smaller (I=67%). Diabetes mellitus (P=0.004), OD=1.50 (1.14, 1.98), I=27% and preoperative pyuria (P=0.002), OD=1.75 (1.23, 2.49), I=20%, were other factors that significantly influenced postoperative evolution. A total of two factors analyzed, body mass index and patient's age, did not influence the outcome, P=0.45, I=58% and P=0.98, I=63%.
随着经皮肾镜取石术（PCNL）等经皮介入治疗肾结石的增加，感染性并发症越来越频繁。本研究对Medline和Embase数据库进行了系统检索，使用了以下检索词：“PCNL”[医学主题词] AND [“脓毒症”（所有字段）OR “PCNL”（所有字段）] AND [“感染性休克”（所有字段）] AND [“尿脓毒症”（医学主题词）OR “全身炎症反应综合征（SIRS）”（所有字段）]。由于腔内泌尿外科技术的进步，检索了2012年至2022年发表的文章。在1403条检索结果中，只有18篇文章符合纳入分析的标准，这些文章共涉及7507例行PCNL的患者。所有作者均对所有患者应用了抗生素预防，在某些情况下，对尿培养阳性的患者在术前进行了感染治疗。根据本研究的分析，术后发生SIRS/脓毒症的患者手术时间明显更长（P = 0.0001），与其他因素相比异质性最高（I = 91%）。术前尿培养阳性的患者在PCNL后发生SIRS/脓毒症的风险显著更高（P = 0.00001），比值比（OD）= 2.92（1.82，4.68），且异质性程度也很高（I = 80%）。进行多通道PCNL也增加了术后SIRS/脓毒症的发生率（P = 0.00001），OD = 2.64（1.78，3.93），异质性稍小（I = 67%）。糖尿病（P = 0.004），OD = 1.50（1.14，1.98），I = 27%和术前脓尿（P = 0.002），OD = 1.75（1.23，2.49），I = 20%，是其他显著影响术后病情演变的因素。总共分析的两个因素，体重指数和患者年龄，对结果没有影响，P = 0.45，I = 58%和P = 0.98，I = 63%。
