Lan Senlin, Liu Bohao, Xie Siwei, Yang Chunting
Department of Urology, Zhangpu Hospital, Zhangzhou City, China.
Department of Urology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
BMC Urol. 2024 Dec 27;24(1):287. doi: 10.1186/s12894-024-01680-9.
This study aims to identify the risk factors for systemic inflammatory response syndrome (SIRS) after minimally invasive percutaneous nephrolithotomy (PCNL) with a controlled irrigation pressure and to find which patients undergoing PCNL are likely to develop SIRS under the pressure-controlled condition.
A total of 303 consecutive patients who underwent first-stage PCNL in our institute between July 2016 and June 2018 were retrospectively reviewed. All the procedures were performed with an 18 F tract using an irrigation pump setting the irrigation fluid pressure at 110 mmHg and the flow rate of irrigation at 0.4 L/min. SIRS and sepsis were recorded after PCNL. The demographic data, clinical features, and test results were analyzed.
52 patients (17.2%) developed SIRS and only 3 patients (0.99%) further progressed to severe sepsis. The results of univariate analysis showed that the stone size, operative time, history of DM, the value of glycosylated hemoglobin, history of ipsilateral surgery, preoperative urine culture, Staghorn calculi, pelvic urine culture, stone culture, number of tracts, blood transfusion, and residual stones were found to have a significant correlation with post-PCNL SIRS (p < 0.05). In multivariate analysis, the stone size (OR = 3.743, p = 0.012), preoperative urine culture (OR = 2.526, p = 0.042), pelvic urine culture (OR = 13.523, p < 0.001), the number of access tracts (OR = 8.945, p = 0.002), blood transfusion (OR = 26.308, p < 0.001) were identified as the independent risk factors for post-PCNL SIRS.
The stone size (>4cm), positive preoperative urine culture, positive pelvic urine culture, multiple tracts, receipt of a blood transfusion are the independent risk factors for SIRS under the pressure-controlled condition. More attention should be paid when the PCNL patients have these risk factors.
本研究旨在确定在控制冲洗压力的情况下，微创经皮肾镜取石术（PCNL）后发生全身炎症反应综合征（SIRS）的危险因素，并找出在压力控制条件下哪些接受PCNL的患者可能发生SIRS。
回顾性分析2016年7月至2018年6月在我院连续接受一期PCNL的303例患者。所有手术均采用18F通道，使用灌注泵将冲洗液压力设置为110 mmHg，冲洗流速设置为0.4 L/min。记录PCNL术后的SIRS和脓毒症情况。分析人口统计学数据、临床特征和检查结果。
52例患者（17.2%）发生SIRS，仅3例患者（0.99%）进一步发展为严重脓毒症。单因素分析结果显示，结石大小、手术时间、糖尿病史、糖化血红蛋白值、同侧手术史、术前尿培养、鹿角形结石、肾盂尿培养、结石培养、通道数量、输血和残余结石与PCNL术后SIRS显著相关（p<0.05）。多因素分析显示，结石大小（OR=3.743，p=0.012）、术前尿培养（OR=2.526，p=0.042）、肾盂尿培养（OR=13.523，p<0.001）、通道数量（OR=8.945，p=0.002）、输血（OR=26.308，p<0.001）被确定为PCNL术后SIRS的独立危险因素。
结石大小（>4cm）、术前尿培养阳性、肾盂尿培养阳性、多通道、输血是压力控制条件下SIRS的独立危险因素。PCNL患者存在这些危险因素时应给予更多关注。
