微创经皮肾镜取石术中结石细菌培养的临床价值

Role of intraoperative stone bacterial culture in percutaneous nephrolithotomy

目的探讨微创经皮肾镜取石术(MPCNL)术前中段尿培养与术中结石培养之间的关系以及结石培养的临床价值。方法回顾性分析2009年1-5月80例行MPCNL的患者术前中段尿培养及术中结石培养的临床资料。所有中段尿培养阳性的患者术前均经静脉途径给予抗生素治疗。分别记录术前中段尿培养及术中结石培养的结果,术后全身炎性反应综合征(SIRS)发生的情况,抗生素的应用及根据结石培养结果进行抗生素调整的情况。结果本组80例患者,术中结石培养阳性率为62.5%(50/80),显著高于术前中段尿培养阳性率[40.0%(32/80),P<0.05]。21例(26.2%)术中结石培养及术前中段尿培养均无细菌生长;9例(11.2%)术前中段尿培养有细菌生长而术中结石培养无细菌生长;23例(28.8%)术前中段尿培养及术中结石培养均有细菌生长,其中18例(22.5%)术前中段尿培养及术中结石培养为不同的病原菌生长;27例(33.8%)术前中段尿培养无细菌生长但术中结石培养有细菌生长。19例(23.8%)术后出现SIRS,均根据术中结石培养的结果调整术后抗生素的使用,SIRS症状平均控制时间为(23.9±4.2)h。结论术中结石培养比术前中段尿培养更能准确反映泌尿系感染的情况。术后应根据术中结石培养的结果调整抗生素的应用。

Objective To evaluate the correlation between preoperative urine culture （UC） and intraoperative stone culture （SC） and the role of SC in clinical application. Methods Preoperative UC and intraoperative SC were prospectively obtained in 80 patients undergoing minimally invasive percutaneous nephrolithotomy （MPCNL） between January 2009 and May 2009. Patients with a positive UC received a full course of antibiotics before surgery. The postoperative systemic inflammatory response syndrome （SIRS） events, antibiotic regimen and any changes in antibiotic treatment secondary to the SC results were recorded. Results There were 50 patients with SC positive results and 32 with UC positive results. The positive rates of SC were significantly higher than UC ones （62.5% vs. 40.0%, P0.05）. Sterile UC and SC results were found in 21 patients （26.8%）. Sterile SC and UC positive results were found in 9 patients （11.2%）. Both urine and renal stones were colonized in 23 patients （28.8%）. Of them, there was different types of pathogenic bacteria in UC and SC in 18 patients （22.5%）. Sterile UC and SC positive results were found in 27 patients （33.8%）. Postoperative SIRS happened in 19 patients （23.8%）. And antibiotic therapy was adjusted in these patients according to the SC findings and the mean control time of SIRS symptoms was （23.9±4.2） h. Conclusion Intraoperative SC can be more accurate to reflect the urinary stone-colonizing bacterial infection than preoperative UC. Antibiotic therapy should be changed according to intraoperative SC results.