肾下盏解剖结构对软式输尿管镜治疗肾下盏结石术后血尿及尿源性脓毒血症的影响

Effects of anatomical structure of subrenal calyx on hematuria and urosepsis after flexible ureteroscopy for the treatment of subrenal calyx calculi

目的了解肾下盏解剖结构对输尿管软镜碎石术(fURL)治疗肾下盏结石术后血尿、尿源性脓毒血症的影响。方法回顾性分析陕西省人民医院2017-2020年住院行软式输尿管镜下肾下盏结石钬激光碎石的患者,比较其临床资料及肾下盏解剖结构数据,二元logistic回归分析影响术后发生血尿、尿源性脓毒血症的独立危险因素,ROC曲线合并约登指数确定连续变量的临界值及曲线下面积(AUC)。结果按纳入及排除标准筛选后共收集肾下盏结石的患者192例,术后发生肉眼血尿41例(21.35%),发生尿源性脓毒血症32例(16.67%);单因素分析显示男性、术后血小板计数较低、肾盂下盏高度较高、下盏盏颈长度较长可能是术后发生肉眼血尿的危险因素(P<0.05),术前尿培养阳性,肾盂下盏高度较高、手术时间较长、术前白细胞计数较高、术前中性粒细胞计数较高可能是术后发生尿源性脓毒血症的危险因素(P<0.05);多因素logistic回归分析显示,下盏盏颈长度及肾盂下盏高度是fURL后发生肉眼血尿的独立危险因素(P<0.05)。肾盂下盏高度是fURL后发生尿源性脓毒血症的独立危险因素(P<0.05)。结论输尿管软镜治疗肾下盏结石患者术后男性更易发生肉眼血尿,肾盂下盏高度增加术后血尿和尿源性脓毒血症风险。

Objective To explore the effects of the anatomical structure of subrenal calyx on hematuria and urosepsis after flexible ureteroscopy for the treatment of subrenal calyx calculi.Methods Clinical and anatomical data of the subrenal calyx of patients who underwent flexible ureteroscopy and holmium laser lithotripsy for subrenal calyx calculi were retrospectively analyzed.Multivariate logistic regression was used to analyze the independent risk factors of postoperative hematuria and urosepsis.Receiver operating characteristic(ROC)curve and Youden index were used to determine the cut-off points of continuous variables and areas under the curve(AUCs).Results A total of 192 patients were included according to the inclusion and exclusion criteria.Postoperative gross hematuria occurred in 41 patients(21.35%),and urosepsis in 32 patients(16.67%).Univariate analysis showed that male,low postoperative platelet count,long infundibular length(IL)and high caliceal-pelvic height(CPH)were risk factors for postoperative gross hematuria(P<0.05),and positive preoperative urine culture,high CPH,operation time,and relatively high preoperative white blood cell and neutrophil counts were risk factors for postoperative urosepsis(P<0.05).Multivariate logistic regression showed that CPH and IL were independent risk factors for postoperative gross hematuria(P<0.05),and CPH was the independent risk factor for postoperative urosepsis(P<0.05).Conclusion Male are prone to develop postoperative gross hematuria after flexible ureteroscopy and CPH increases the risk of postoperative hematuria and urosepsis.