腹腔镜肾盂成形术后双J管相关泌尿系统感染的危险因素分析

Analysis of risk factors of double J stent-related infection after laparoscopic pyeloplasty

目的分析小儿肾盂输尿管连接部梗阻行腹腔镜肾盂成形术后,留置双J管期间发生泌尿系统感染的危险因素。方法回顾性分析2015年11月至2020年10月由山东大学附属省立医院收治的单侧肾盂输尿管连接部梗阻、行腹腔镜肾盂成形术并留置双J管的患者121例,根据留置双J管期间是否发生泌尿系统感染,将患者分为感染组(n=14)和非感染组(n=107),分析泌尿系统感染的发生与患者的年龄、体重、性别、侧别、术前有无临床症状、肾盂前后径、肾皮质厚度、患肾分肾功能及双J管型号的关系。结果留置双J管期间发生泌尿系统感染14例(11.57%)。本研究显示感染组与非感染组中性别、侧别、肾盂前后径、患肾分肾功能及双J管型号差异无统计学意义(P>0.05),而年龄(P=0.02)、体重(P=0.02)、术前有无临床症状(P=0.04)和肾皮质厚度(P=0.003)差异有统计学意义。进一步对年龄、体重、术前肾皮质厚度、术前有无临床症状进行二元Logistic回归分析,发现体重(OR=0.847,95%CI:0.721~0.994)和肾皮质厚度(OR=0.007,95%CI:0.000~0.491)是术后泌尿系统感染的独立危险因素。体重和术前肾皮质厚度预测术后是否发生泌尿系统感染的ROC曲线下区面积分别为0.70(95%CI:0.58~0.81,P<0.05)和0.74(95%CI:0.60~0.88,P<0.01),最佳截断值分别为13.75 kg和0.25 cm。结论双J管相关性泌尿系统感染是腹腔镜肾盂成形术后较常见的并发症,体重<13.75 kg、术前肾皮质厚度<0.25 cm是术后泌尿系统感染的独立危险因素。

Objective To explore the risk factors of double J stent-related urinary tract infection after laparoscopic pyeloplasty(LP)in patients with ureteropelvic junction obstruction(UPJO).Methods A total of 121 UPJO children undergoing primary transperitoneal LP between November 2015 and October 2020 were retrospectively reviewed.Double J stents were inserted.According to the occurrence of urinary tract infection during indwelling double J stent,they were divided into infection and non-infection groups.Differences in age,body weight,gender,sideness,preoperative presentation,anteroposterior pelvic diameter,renal cortical thickness,split renal function and type of double J stent were compared.Results Double J stent related infection occurred in 14 cases(11.57%).Statistical analysis revealed no significant inter-group difference in gender,sideness,anteroposterior pelvic diameter,renal function or double J tube type.However,age(P=0.02),body weight(P=0.02),preoperative presentation(P=0.04)and renal cortex thickness(P=0.003)were significantly different between two groups.Body weight<13.75 kg and renal cortical thickness<0.25 cm were risk factors of postoperative double J stent-related infection.Conclusion Double J stent-related infection is a common complication after LP.Body weight and renal cortical thickness are risk factors for this complication.Children with low weight and renal cortical thickness should be closely watched for the occurrence of double J stent-related infection.