结石梗阻出现化脓性肾盂肾炎患者术后转归影响因素

Influencing factors of postoperative outcome in patients with calculus obstructive pyonephrosis

目的探讨结石梗阻出现化脓性肾盂肾炎患者行内镜结石清除术手术后肾功能转归的影响因素。方法选取自2014年4月至2017年5月收治的134例结石梗阻出现化脓性肾盂肾炎患者为研究对象,患者均为初次诊断,并行内镜结石清除术。出院后,患者均行12个月随访。根据患者血肌酐水平将患者分为肾功能转归组(血肌酐<110μmol/L,n=73)与肾功能损伤组(血肌酐≥110μmol/L,n=61)。记录患者临床资料,行血常规、尿常规、肾小球滤过率等指标检测及超声、CT检查,对患者肾功能进行评估,分析患者肾功能转归的影响因素。结果 134例患者术后出现结石残留21例(15. 7%),围术期出现炎症反应102例(76. 1%),尿源性败血症3例(2. 2%)。研究过程中,未出现入住重症监护室或死亡患者。随访12个月时,患者血肌酐为(94. 6±21. 3)μmol/L,低于术前的(109. 3±23. 6)μmol/L,差异有统计学意义(P <0. 05)。单因素分析结果显示,患者年龄、结石梗阻时间、术前肾小球滤过率、肾周感染与患者术后肾功能转归有关(P <0. 05)。多因素Logistic回归分析结果显示,患者年龄、结石梗阻时间、术前肾小球滤过率、肾周感染是结石梗阻出现化脓性肾盂肾炎患者术后肾功能转归的独立危险因素(P <0. 05)。结论结石梗阻出现化脓性肾盂肾炎患者在控制感染的前提下行内镜取石术较为安全,术后患者预后情况较好。患者年龄、结石梗阻时间、术前肾小球滤过率、肾周感染是术后肾功能转归的独立危险因素。

Objective To investigate the influencing factors of postoperative outcome in patients with calculus obstructive pyonephrosis.Methods A retrospective study was performed on 134 cases of patients with calculus obstructive pyonephrosis who were admitted from April 2014 to May 2017.All patients were diagnosed for the first time and underwent endoscopic stone removal.Afterdischarge,all patients were followed up for 12 months.Patients were divided into the renal function outcome group(creatinine less than 110μmol/L,n=73)and the renal function impairment group(creatinine more than 110μmol/L,n=61)according to their blood creatinine levels.The clinical data of the patients were recorded,bloodroutine,urineroutine,glomerular filtration rate and other indicators were detected,and ultrasound and CT examinations were performed.The renal function of the patients was evaluated,and the influencing factors of renal function were analyzed.Results The postoperative stone residual rate of 134 patients was 15.7%;the perioperative inflammatory reaction was 76.1%(102 cases);the urinary sepsis was 2.2%(3 cases).There were no aggravated signs for death or ICU in postoperative patients.Followed up for 12 months,serum creatine level was(94.6±21.3)μmol/L,which was lower than preoperative level(109.3±23.6)μmol/L(P<0.05).Univariate analysis showed that age,stone obstruction time,preoperative glomerular filtration rate and perinenal infection were related to postoperative renal function outcome(P<0.05).Multivariate Logistic regression analysis showed that age,stone obstruction time,preoperative glomerular filtration rate,andperinenal infection were independent risk factors for postoperative renal function in patients with pyelonephritis caused by stone obstruction(P<0.05).Conclusion Endoscopic stone removal is safe in patients with pyonephrosis under the premise of infection control.The prognosis of postoperative patients is better.Theelderly,severe renal function damage and excessive infection range are the independent risk factors for the renal function outcomes after endoscopic stone removal.