置管方式及时间对肾盂输尿管成形术后患儿尿路感染的影响

Effect of different insertion technique and indwelling time of urethral catheter on urinary tract infection after pyeloureteroplasty

目的：探讨置管方式及时间对肾盂输尿管（UPJ）成形术后患儿尿路感染发生的影响。方法收集371例 UPJ 成形术患儿的临床资料。根据置管方式不同，分为双 J 管组（245例）、外支架管组（103例）和无支架管组（23例）。双 J 管组中根据术后双 J 管留置时间长短分为≤45 d组（A 组）、46～105 d 组（B 组）和＞105 d 组（C 组）。所有患儿根据有无尿路感染分为尿路感染组（126例）和无尿路感染组（245例）。分别收集各组患儿的术前临床资料及定期复查的尿常规、尿培养结果，比较各组尿白细胞阳性率、尿白细胞阳性次数、尿培养阳性率、住院治疗率、门诊治疗率、抗生素使用情况、远期手术成功率间的差异。结果双 J 管组、外支架管组、无支架管组患儿在术前或术后早期的尿路感染率组间比较差异均无统计学意义（P 均＞0.05）；出院后双 J 管组尿路感染发生率高达21.7％，高于外支架管组（2.1％，P ＜0.01）及无支架管组（0％，P ＜0.017）。术后双 J 管组尿白细胞阳性次数多于外支架管组，其门诊治疗率和住院治疗率均高于外支架管组（P 均＜0.017）。与无支架管组比较，双 J 管组尿白细胞阳性次数较多，尿白细胞阳性率、尿培养阳性率和门诊治疗率较高（P 均＜0.017）。双 J 管组各亚组尿白细胞阳性率、尿常规阳性次数、出院后抗生素使用率的比较中，均为 A 组＜B 组＜C 组（P 均＜0.017），A 组尿培养阳性率和住院治疗率低于 B、C组（P 均＜0.017），A、B 组门诊治疗率低于 C 组（P 均＜0.017）。尿路感染组的远期手术成功率（89.7％）低于无尿路感染组的96.7％（P ＜0.01）。结论双 J 管的留置增加了尿路感染风险及严重程度，尿路感染的发生影响肾积水手术远期疗效，建议术后1个月内拔除双 J 管。

Objective To evaluate the effect of different catheter insertion technique and indwelling time upon the incidence of urinary tract infection in the children who underwent pyeloureteroplasty. Methods Clinical data of 371 children undergoing pyeloureteroplasty were collected. According to the catheter insertion technique, all participants were divided into double J stent （n = 2 4 5 ） , external stent （n = 103） and stent-less groups （n = 23）. Based upon postoperative indwelling time, children in the double J stent group were further divided into the A （indwelling time ^45 d） , B （46-105 d） and C subgroups （ 〉105 d）. All children were divided into the urinary tract infection （n = 126） and non-urinary tract infection groups （n = 2 4 5 ） . Preopera-tive clinical data, routine urine examination and urine culture results were obtained. The positive rate of white blood cell in urine, frequency of positive white blood cell in urine, positive rate of urine culture test, percent-age of hospitalization treatment, percentage of outpatient treatment, use of antibiotics and long-term success rate of surgery were statistically compared among all groups. Results The urinary tract infection rate before and early after surgery did not significantly differ among the double J stent, external stent and stent-less groups （all P 〉0. 05）. After hospital discharge, the percentage of urinary tract infection in the double J stent group wasup to 21. 7% , significantly higher compared with 2. 1% in the external stent （P 〈 0. 0 1 ） and 0% in the stent-less groups （P 〈0. 017） . In the double J stent group, postoperative frequency of positive white blood cell in urine, percentage of outpatient and hospitalization treatment were all higher compared with those in the exter-nal stent group （ all P 〈 0. 017 ）. Compared with the stent-less group, the frequency of positive white blood cell in urine,positive rate of white blood cell in urine, positive rate of urine culture test and percentage of outpa-tient treatment were significantly higher in the double J stent group （all P 〈0. 0 1 7 ） . In the A subgroup, the positive rate of white blood cell in urine, frequency of positive white blood cell in urine and use of antibiotics after hospital discharge were significantly lower compared with those in the B and C subgroups （ all P 〈0. 0 1 7 ） . The positive rate of urine culture test and percentage of hospitalization treatment in the A subgroup were consid-erably lower than those in the B and C subgroups （ all P 〈 0. 017 ）. The percentage of outpatient treatment in the A and B subgroups was significantly lower compared with that in the C subgroup （both P 〈0. 017）. In the urinary tract infection group, the long-term success rate of success rate was calculated as 89.1% , significantly lower than 96. 7% in the non-urinary tract infection group （ P 〈 0. 01）. Conclusions Indwelling of double J stent increases the risk and severity of urinary tract infection. The incidence of urinary tract infection affects the long-term efficacy of hydronephrosis surgery. It is recommended to remove the double J stent at postoperative 1 month.