输尿管软镜钬激光碎石术治疗肾盏憩室结石术后全身炎症反应综合征及残石存在的研究

Associated Factors of SIRS and Residual Stones after Flexible Ureteroscopic Holmium Laser Lithotripsy for Calyceal Diverticular Stones

目的探讨输尿管软镜钬激光碎石术治疗肾盏憩室结石术后全身炎症反应综合征(SIRS)和残石存在发生情况。方法选取2012年9月—2015年7月郑州大学第二附属医院诊断为肾盏憩室结石的患者共30例为研究对象,所有患者经肾-输尿管-膀胱摄影(KUB)+静脉肾盂造影(IVP)或CT尿路造影(CTU)检查后诊断为肾盏憩室结石并行输尿管软镜钬激光碎石术治疗。记录术后SIRS发生情况,术后1个月及3个月复查双肾CT平扫了解残石存在情况。结果手术时间(67.3±21.2)min,术中出血量(7.0±4.1)ml,术后住院天数(4.1±2.7)d。术后发生SIRS 6例(20.0%),给予积极抗感染、补液等对症处理后均未发生尿脓毒血症及感染性休克。术后1个月残石存在6例,残石存在率为20.0%;术后3个月残石存在5例,残石存在率为16.7%。不同性别、年龄、结石直径、结石位置、结石数量、肾盂肾盏夹角患者SIRS发生情况比较,差异均无统计学意义(P>0.05);是否合并糖尿病、术中有无感染迹象、是否有感染性结石成分患者SIRS发生情况比较,差异均有统计学意义(P<0.05)。不同性别、年龄、结石直径、结石数量、是否合并糖尿病、术中有无感染迹象、是否有感染性结石成分患者术后残石存在发生情况比较,差异均无统计学意义(P>0.05);不同结石位置、肾盂肾盏夹角患者术后残石存在发生情况比较,差异均有统计学意义(P<0.05)。结论输尿管软镜钬激光碎石术是目前治疗肾盏憩室结石比较安全、有效的方法之一,但对有发生SIRS危险因素的患者要注意术后感染的防治。对有残石存在危险因素的患者要做好术前手术方式的选择及术后排石的工作。

Objective To investigate the associated factors of systemic inflammatory response syndrome（SIRS） and residual stones after flexible ureteroscopic holmium laser lithotripsy for calyceal diverticular stones.Methods The 30 participants enrolled in this study were from the Second Affiliated Hospital of Zhengzhou University,they were diagnosed with calyceal diverticular stones between September 2012 and July 2015 by kidney-ureter-bladder（KUB） abdominal radiography combined with intravenous pyelography（IVP） or CT urography（CTU） and treated by flexible ureteroscopic holmium laser lithotripsy.Postoperative SIRS occurred in the participants were observed and recorded.CT plain scanning was performed in all of them at the time of 1,3 months after the surgery for detecting the residual stones in bilateral kidneys.Results The average intraoperative duration,intraoperative blood loss and postoperative hospital stay was（67.3±21.2）min,（7.0±4.1） ml,（4.1±2.7） days,respectively.Twenty percent of them（6/30） had postoperative SIRS,but no urosepsis and septic shock after receiving the treatment against infection,fluid infusion and other symptomatic treatment.The residual stone rate detected by the CT scanning performed at the time of 1,3 months after the surgery was 20.0%（6/30）,and 16.7%（5/30）,respectively.Among the participants,the incidence of SIRS was significantly associated with diabetes,intraoperative infection,and infection-related stone fragments（P〈0.05）,while it was not associated with gender,age,kidney stone size,location and amount,angle between the renal pelvis and calyce（P〉0.05）;the incidence of postoperative residual stones was substantially associated with kidney stone location and angle between the renal pelvis and calyce（P〈0.05）,but not with gender,age,kidney stone size and amount,diabetes,intraoperative infection,and infection-related stone fragments（P〉0.05）.Conclusion Ureteroscopic holmium laser lithotripsy is one of the safe and effective ways for the treatment of calyceal diverticular stones.For patients with the risk factors for SIRS,attention should be paid to the prevention and treatment of postoperative infection;for those with the risk factors for residual stones,surgical method and management option for residual stones should be selected carefully.