术前预警评分系统在上尿路结石合并重度肾积水患者行腔内碎石治疗中的应用研究

Application of intracavity lithotripsy pre-operation warming score system for upper urinary calculi patients with serious hydronephrosis

目的评估术前预警评分系统(POWSS)在上尿路结石合并重度肾积水患者行腔内碎石治疗中的应用价值。方法回顾性分析2013年1月到2017年7月在本院行上尿路腔内碎石治疗的重度肾积水患者147例的临床资料,POWSS评分>7.5分者89例为高分组,其中41例术前行肾穿刺造瘘;POWSS评分≤7.5分者58例为低分组,其中19例术前行肾穿刺造瘘。对比两组患者的术后感染发生率结果高分组未穿刺造瘘的患者术后感染率为35.42%(17/48),显著高于低分组未穿刺造瘘患者的5.13%(2/39),两组比较差异有统计学意义(P=0.001),而进行术前穿刺造瘘的高分组患者术后感染率为7.32%(3/41),显著低于术前未穿刺造瘘的高分组患者(P=0.002)。结论POWSS评分能筛选出上尿路结石患者行腔内碎石发生术后感染的高危人群,对于重度肾积水的高危患者宜术前行患侧肾穿刺造瘘术,以降低感染发生率。

Objective To evaluated the value of pre-operation warming score system(POWSS)in upper urinary calculi patients with serious hydronephrosis.Methods From January 2013 to July 2017,147 upper urinary calculi patients with serious hydronephrosis who undenvent intracavity lithotripsy were analyzed.Eighty-nine patients who were rated>7.5 with POWSS were divided into high-score group,which included 41 patients who undement percutaneous nephrectomy.Fifty-eight patients who were rated≤7.5 with POWSS were divided into low-score group,which included 19 patients who underwent percutaneous nephrectomy,infection rate after intracavity lithotripsy were compared between two groups.Results The infection rate after intracavity lithotripsy of patients without percutaneous nephrectomy in high-score group and low-score group were 35.42% and 5.13% respectively,there was a significant difference between two groups(P=0.001).Percutaneous nephrectomy before intracavity lithotripsy in high-score upper urinary calculi patients could reduced the infection rate(7.32%vs.35.42%,P=0.002).Conclusions POWSS could sifted out high-risk patients of infection after intracavity lithotripsy in upper urinary calculi,percutaneous nephrectomy before intracavity lithotripsy contributed to the reduction of infection rate in high-risk upper urinary calculi patients with serious hydronephrosis.