与吸尘器程序相比，在感染高风险患者中，真空辅助微经皮肾镜取石术与较低的感染性并发症发生率相关：单中心经验。
Vacuum-assisted mini-percutaneous nephrolithotomy is associated with lower rates of infectious complications compared to vacuum-cleaner procedure in patients at high risk for infections: a single-center experience.
机构信息
Department of Urology, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
出版信息
World J Urol. 2024 Mar 27;42(1):200. doi: 10.1007/s00345-024-04897-3.
PURPOSE
To evaluate the impact of vacuum-assisted mini-percutaneous nephrolithotomy (vamPCNL) vs. vacuum-cleaner mPCNL (vcmPCNL) on the rate of postoperative infectious complications in a cohort of patients with high risk factors for infections.
METHODS
We retrospectively analysed data from 145 patients who underwent mPCNL between 01/2016 and 12/2022. Patient's demographics, stones characteristics and operative data were collected. vamPCNL and vcmPCNL were performed based on the surgeon's preference. High-risk patients were defied as having ≥ 2 predisposing factors for infections such as a history of previous urinary tract infections, positive urine culture before surgery, stone diameter ≥ 3 cm, diabetes mellitus and hydronephrosis. Complications were graded according to modified Clavien classification. Descriptive statistics and logistic regression models were used to identify factors associated with postoperative infectious complications.
RESULTS
vamPCNL and vcmPCNL were performed in 94 (64.8%) and 51 (35.2%) cases, respectively. After surgery, infectious complications occurred in 43 (29.7%) participants. Patients who developed infectious complications had larger stone volume (p = 0.02) and higher rate of multiple stones (p = 0.01) than those who did not. Infectious complications occurred more frequently after vcmPCNL than vamPCNL (55.9% vs. 44.1%. p = 0.01) in high-risk patients. Longer operative time (p < 0.01) and length of stay (p < 0.01) were observed in cases with infectious complications. At multivariable logistic regression analysis, longer operative time (OR 1.1, p = 0.02) and vcmPCNL (OR 3.1, p = 0.03) procedures were independently associated with the risk of infectious complications post mPCNL, after accounting for stone volume.
CONCLUSION
One out of three high-risk patients showed infectious complications after mPCNL. vamPCL and shorter operative time were independent protective factors for infections after surgery.
目的
评估在一组具有感染高危因素的患者中，真空辅助微经皮肾镜取石术（vamPCNL）与真空清洁器微经皮肾镜取石术（vcmPCNL）对术后感染并发症发生率的影响。
方法
我们回顾性分析了 2016 年 1 月至 2022 年 12 月期间接受 mPCNL 的 145 例患者的数据。收集了患者的人口统计学、结石特征和手术数据。根据外科医生的偏好进行 vamPCNL 和 vcmPCNL。高危患者定义为具有≥2 个感染易患因素，如既往尿路感染史、术前尿液培养阳性、结石直径≥3cm、糖尿病和肾积水。并发症根据改良 Clavien 分类进行分级。采用描述性统计和逻辑回归模型来确定与术后感染性并发症相关的因素。
结果
94 例（64.8%）和 51 例（35.2%）患者分别行 vamPCNL 和 vcmPCNL。术后，43 例（29.7%）患者发生感染性并发症。发生感染性并发症的患者结石体积较大（p=0.02），多发性结石比例较高（p=0.01）。高危患者中，vcmPCNL 术后感染并发症发生率高于 vamPCNL（55.9% vs. 44.1%，p=0.01）。发生感染性并发症的病例手术时间较长（p<0.01），住院时间较长（p<0.01）。多变量逻辑回归分析显示，手术时间较长（OR 1.1，p=0.02）和 vcmPCNL（OR 3.1，p=0.03）是 mPCNL 术后感染并发症的独立危险因素，考虑到结石体积后。
结论
高危患者中有三分之一在 mPCNL 后出现感染性并发症。vamPCL 和较短的手术时间是术后感染的独立保护因素。
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