经皮肾镜取石术后发热的危险因素分析
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摘要
目的:探讨肾结石患者行经皮肾镜取石术(PCNL)后发热的危险因素。方法:回顾性分析2014年1月～2017年6月我院收治的183例因肾结石行PCNL患者的临床资料,其中男97例,女86例,平均年龄(53.6±13.1)岁。术前尿WBC异常152例,中段尿培养阳性36例。对围手术期可能导致PCNL术后发热的因素进行单因素和多因素Logistic回归分析。结果:183例患者手术均顺利完成,平均手术时间(114.3±52.2)min,平均估计出血量(41.1±63.8)ml,术后结石残留82例(44.8%),术后发热29例(15.8%)。单因素Logistic回归分析发现慢性肾脏病(CKD)分期、尿WBC计数、术后结石残留为术后发热的危险因素,而年龄、性别、肾积水程度、中段尿培养阳性、糖尿病、手术时间、术中估计出血量、ASA分级、S.T.O.N.E.评分及Guy's评分与术后发热无关。多因素Logistic回归分析结果表明术后结石残留为PCNL术后发热的独立危险因素(OR=2.486,95%CI:1.169～5.780,P=0.034)。结论:术后结石残留是预测PCNL术后发热的独立危险因素。
Objective:To evaluate the risk factors for fever after percutaneous nephrolithotomy(PCNL).Method:Between January 2014 and June 2017,183 PCNLs were performed at our hospital.The risk factors for fever were evaluated by a retrospective chart review.There were 97 men and 86 women,whose mean age was(53.6±13.1)years old.One hundred and fifty-two patients had abnormal WBC count in urine analysis and 36 had positive midstream urine culture preoperatively.Regression analysis was performed to determine the risk factors for fever after PCNL.Result:All 183 PCNLs were successfully completed,with average operation time(114.3±52.2)min and mean blood loss(41.1±63.8)ml.The overall stone-residual rate was 44.8% and 29 patients(15.8%)experienced fever after PCNL.Univariate regression analysis showed that chronic kidney disease(CKD)stages,WBC count of urine analysis,incomplete stone extraction were risk factors for fever after PCNL,but the age,gender,degree of hydronephrosis,positive urine culture,diabetes,operation time,mean blood loss,ASA classification,S.T.O.N.E.score and the Guy's grade were not significantly associated with postoperative fever.Multivariate regression analysis revealed that only incomplete stone extraction was an independent risk factor for the development of fever after PCNL.Conclusion:Incomplete stone extraction is a major risk factor for the development of fever after PCNL.
Objective:To evaluate the risk factors for fever after percutaneous nephrolithotomy(PCNL).Method:Between January 2014 and June 2017,183 PCNLs were performed at our hospital.The risk factors for fever were evaluated by a retrospective chart review.There were 97 men and 86 women,whose mean age was(53.6±13.1)years old.One hundred and fifty-two patients had abnormal WBC count in urine analysis and 36 had positive midstream urine culture preoperatively.Regression analysis was performed to determine the risk factors for fever after PCNL.Result:All 183 PCNLs were successfully completed,with average operation time(114.3±52.2)min and mean blood loss(41.1±63.8)ml.The overall stone-residual rate was 44.8% and 29 patients(15.8%)experienced fever after PCNL.Univariate regression analysis showed that chronic kidney disease(CKD)stages,WBC count of urine analysis,incomplete stone extraction were risk factors for fever after PCNL,but the age,gender,degree of hydronephrosis,positive urine culture,diabetes,operation time,mean blood loss,ASA classification,S.T.O.N.E.score and the Guy's grade were not significantly associated with postoperative fever.Multivariate regression analysis revealed that only incomplete stone extraction was an independent risk factor for the development of fever after PCNL.Conclusion:Incomplete stone extraction is a major risk factor for the development of fever after PCNL.
引文
1 Draga R O,Kok E T,Sorel M R,et al.Percutaneous nephrolithotomy:factors associated with fever after the first postoperative day and systemic inflammatory response syndrome[J].J Endourol,2009,23(6):921-927.
2 Michel M S,Trojan L,Rassweiler J J.Complications in percutaneous nephrolithotomy[J].Eur Urol,2007,51(4):899-906.
3 Thomas K,Smith N C,Hegarty N,et al.The Guy's stone score-grading the complexity of percutaneous nephrolithotomy procedures[J].Urology,2011,78(2):277-281.
4 Okhunov Z,Friedlander J I,George A K,et al.S.T.O.N.E.nephrolithometry:novel surgical classification system for kidney calculi[J].Urology,2013,81(6):1154-1159.
5王树声,甘澍,向松涛,等.X线下“两点一角”体表定位PCNL治疗复杂性肾结石的临床分析[J].中华泌尿外科杂志,2013,34(4):250-253.
6 Wang Y,Jiang F,Wang Y,et al.Post-percutaneous nephrolithotomy septic shock and severe hemorrhage:a study of risk factors[J].Urol Int,2012,88(3):307-310.
7 Korets R,Graversen J A,Kates M,et al.Post-percutaneous nephrolithotomy systemic inflammatory response:aprospective analysis of preoperative urine,renal pelvic urine and stone cultures[J].J Urol,2011,186(5):1899-1903.
8 Koras O,Bozkurt I H,Yonguc T,et al.Risk factors for postoperative infectious complications following percutaneous nephrolithotomy:aprospective clinical study[J].Urolithiasis,2015,43(1):55-60.
9 Bansal S S,Pawar P W,Sawant A S,et al.Predictive factors for fever and sepsis following percutaneous nephrolithotomy:A review of 580 patients[J].Urol Ann,2017,9(3):230-233.
10 Rivera M,Viers B,Cockerill P,et al.Pre-and Postoperative Predictors of Infection-Related Complications in Patients Undergoing Percutaneous Nephrolithotomy[J].J Endourol,2016,30(9):982-986.
11杨明根,郑周达,许振强,等.抗生素对经皮肾镜取石术后感染并发症预防效果的Meta分析[J].中华外科杂志,2013,51(10):922-927.
12 Chew B H,Miller N L,Abbott J E,et al.A Randomized Control Trial of Preoperative Prophylactic Antibiotics Prior to Percutaneous Nephrolithotomy in Low Infectious Risk Population:A Report from the EDGE Consortium[J].J Urol,2018,200(4):801-808.
13乔庐东,陈山,马小军,等.上尿路结石患者围手术期抗菌药物应用的专家意见[J].中华泌尿外科杂志,2017,38(9):641-643.
14 Walton-Diaz A,Vinay J I,Barahona J,et al.Concordance of renal stone culture:PMUC,RPUC,RSC and postPCNL sepsis-a non-randomized prospective observation cohort study[J].Int Urol Nephrol,2017,49(1):31-35.
15陈亮,李建兴,黄晓波,等.一期经皮肾镜手术治疗无发热结石性脓肾术后发生全身炎症反应综合征的危险因素分析[J].北京大学学报(医学版),2014,46(4):566-569.
16潘俊,桂泽红,王昭辉,等.S.T.O.N.E.肾结石评分系统预测经皮肾镜取石术后结石残留的临床研究及改良[J].临床泌尿外科杂志,2016,31(5):448-452.
17郑秀龙,李延江,荆涛,等.S.T.O.N.E.评分系统与经皮肾镜取石术并发症的相关性研究[J].临床泌尿外科杂志,2018,33(11):894-898.
18周立权,徐广龙,邓耀良,等.S.T.O.N.E.肾结石评分系统预测PCNL结石清除率及并发症的临床应用价值分析[J].临床泌尿外科杂志,2018,33(2):89-92.
19 Jou Y C,Lu C L,Chen F H,et al.Contributing factors for fever after tubeless percutaneous nephrolithotomy[J].Urology,2015,85(3):527-530.
2 Michel M S,Trojan L,Rassweiler J J.Complications in percutaneous nephrolithotomy[J].Eur Urol,2007,51(4):899-906.
3 Thomas K,Smith N C,Hegarty N,et al.The Guy's stone score-grading the complexity of percutaneous nephrolithotomy procedures[J].Urology,2011,78(2):277-281.
4 Okhunov Z,Friedlander J I,George A K,et al.S.T.O.N.E.nephrolithometry:novel surgical classification system for kidney calculi[J].Urology,2013,81(6):1154-1159.
5王树声,甘澍,向松涛,等.X线下“两点一角”体表定位PCNL治疗复杂性肾结石的临床分析[J].中华泌尿外科杂志,2013,34(4):250-253.
6 Wang Y,Jiang F,Wang Y,et al.Post-percutaneous nephrolithotomy septic shock and severe hemorrhage:a study of risk factors[J].Urol Int,2012,88(3):307-310.
7 Korets R,Graversen J A,Kates M,et al.Post-percutaneous nephrolithotomy systemic inflammatory response:aprospective analysis of preoperative urine,renal pelvic urine and stone cultures[J].J Urol,2011,186(5):1899-1903.
8 Koras O,Bozkurt I H,Yonguc T,et al.Risk factors for postoperative infectious complications following percutaneous nephrolithotomy:aprospective clinical study[J].Urolithiasis,2015,43(1):55-60.
9 Bansal S S,Pawar P W,Sawant A S,et al.Predictive factors for fever and sepsis following percutaneous nephrolithotomy:A review of 580 patients[J].Urol Ann,2017,9(3):230-233.
10 Rivera M,Viers B,Cockerill P,et al.Pre-and Postoperative Predictors of Infection-Related Complications in Patients Undergoing Percutaneous Nephrolithotomy[J].J Endourol,2016,30(9):982-986.
11杨明根,郑周达,许振强,等.抗生素对经皮肾镜取石术后感染并发症预防效果的Meta分析[J].中华外科杂志,2013,51(10):922-927.
12 Chew B H,Miller N L,Abbott J E,et al.A Randomized Control Trial of Preoperative Prophylactic Antibiotics Prior to Percutaneous Nephrolithotomy in Low Infectious Risk Population:A Report from the EDGE Consortium[J].J Urol,2018,200(4):801-808.
13乔庐东,陈山,马小军,等.上尿路结石患者围手术期抗菌药物应用的专家意见[J].中华泌尿外科杂志,2017,38(9):641-643.
14 Walton-Diaz A,Vinay J I,Barahona J,et al.Concordance of renal stone culture:PMUC,RPUC,RSC and postPCNL sepsis-a non-randomized prospective observation cohort study[J].Int Urol Nephrol,2017,49(1):31-35.
15陈亮,李建兴,黄晓波,等.一期经皮肾镜手术治疗无发热结石性脓肾术后发生全身炎症反应综合征的危险因素分析[J].北京大学学报(医学版),2014,46(4):566-569.
16潘俊,桂泽红,王昭辉,等.S.T.O.N.E.肾结石评分系统预测经皮肾镜取石术后结石残留的临床研究及改良[J].临床泌尿外科杂志,2016,31(5):448-452.
17郑秀龙,李延江,荆涛,等.S.T.O.N.E.评分系统与经皮肾镜取石术并发症的相关性研究[J].临床泌尿外科杂志,2018,33(11):894-898.
18周立权,徐广龙,邓耀良,等.S.T.O.N.E.肾结石评分系统预测PCNL结石清除率及并发症的临床应用价值分析[J].临床泌尿外科杂志,2018,33(2):89-92.
19 Jou Y C,Lu C L,Chen F H,et al.Contributing factors for fever after tubeless percutaneous nephrolithotomy[J].Urology,2015,85(3):527-530.