经内镜碎石术治疗上尿路结石后发生全身炎症反应综合征的危险因素。
Risk factors for systemic inflammatory response syndrome after endoscopic lithotripsy for upper urinary calculi.
机构信息
Urology Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310006, China.
Nursing Department, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310006, China.
出版信息
BMC Urol. 2023 Apr 11;23(1):59. doi: 10.1186/s12894-023-01230-9.
BACKGROUND
To explore the risk factors for systemic inflammatory response syndrome (SIRS) after endoscopic lithotripsy for upper urinary calculi.
METHODS
This retrospective study included patients with upper urinary calculi who underwent endoscopic lithotripsy in the First Affiliated Hospital of Zhejiang University between June 2018 and May 2020.
RESULTS
A total of 724 patients with upper urinary calculi were included. One hundred and fifty-three patients developed SIRS after the operation. The occurrence of SIRS was higher after percutaneous nephrolithotomy (PCNL) compared with ureteroscopy (URS) (24.6% vs. 8.6%, P < 0.001) and after flexible ureteroscopy compared with ureteroscopy (fURS) (17.9% vs. 8.6%, P = 0.042). In the univariable analyses, preoperative infection history (P < 0.001), positive preoperative urine culture (P < 0.001), history of kidney operation on the affected side (P = 0.049), staghorn calculi (P < 0.001), stone long diameter (P = 0.015), stone limited to the kidney (P = 0.006), PCNL (P = 0.001), operative time (P = 0.020), and percutaneous nephroscope channel (P = 0.015) were associated with SIRS. The multivariable analysis showed that positive preoperative urine culture [odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.18-4.24, P = 0.014] and operative methods (PCNL vs. URS, OR = 2.59, 95% CI: 1.15-5.82, P = 0.012) were independently associated with SIRS.
CONCLUSION
Positive preoperative urine culture and PCNL are independent risk factors for SIRS after endoscopic lithotripsy for upper urinary calculi.
背景
探讨上尿路结石内镜碎石术后全身炎症反应综合征（SIRS）的危险因素。
方法
本回顾性研究纳入 2018 年 6 月至 2020 年 5 月在浙江大学第一附属医院接受内镜碎石术的上尿路结石患者。
结果
共纳入 724 例上尿路结石患者，术后 153 例发生 SIRS。经皮肾镜取石术（PCNL）后 SIRS 的发生率高于输尿管镜（URS）（24.6% vs. 8.6%，P<0.001），与输尿管软镜（fURS）相比（17.9% vs. 8.6%，P=0.042）。单因素分析显示，术前感染史（P<0.001）、术前尿培养阳性（P<0.001）、同侧肾手术史（P=0.049）、鹿角形结石（P<0.001）、结石长径（P=0.015）、结石局限于肾脏（P=0.006）、PCNL（P=0.001）、手术时间（P=0.020）和经皮肾镜通道（P=0.015）与 SIRS 相关。多因素分析显示，术前尿培养阳性（OR=2.23，95%CI：1.18-4.24，P=0.014）和手术方式（PCNL 与 URS，OR=2.59，95%CI：1.15-5.82，P=0.012）是 SIRS 的独立危险因素。
结论
术前尿培养阳性和 PCNL 是上尿路结石内镜碎石术后 SIRS 的独立危险因素。
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