结石细菌培养对输尿管软镜碎石术后感染防治的临床研究

Clinical study on prevention and treatment of infection after ureteroscopic lithotripsy by stone bacterial culture

目的探究结石细菌培养在输尿管软镜碎石术后感染防治中的应用。方法选取2020年5月至2021年9月该院收治的行输尿管软镜碎石术上尿路结石患者161例,所有患者均进行术前尿细菌培养、术中取结石进行结石细菌培养。分析比较手术前后C反应蛋白、降钙素原、中性粒细胞计数和临床指标(包括结石清除率、术后住院时间、并发症发生率等),评估输尿管软镜碎石术疗效与安全性。比较结石、尿细菌培养阳性率与细菌谱的差异,评估术后发生感染性并发症的相关危险因素,分析术后发生感染性并发症与尿、结石细菌培养的相关性。结果161例患者住院时间3~12 d,平均(5.47±1.56)d;术后2 d平片检查结果显示无明显残余,结石清除率达92.55%;术后感染性并发症发生率为16.15%。与尿细菌培养比较,结石细菌培养阳性率明显更低,差异有统计学意义(P<0.05)。结石、尿细菌培养,以及结石直径是影响术后感染性并发症发生率的危险因素,结石、尿细菌培养阳性率与术后感染性并发症发生率呈明显正相关性(r=0.513、0.386,P=0.001)。结石、尿细菌培养联合预测术后感染性并发症灵敏度为80.8%,特异度为75.6%,受试者工作特征曲线的曲线下面积为0.823。结论输尿管软镜碎石术具有疗效好、安全性高等特点,取术中结石进行结石细菌培养可提高预测术后感染性并发症发生的准确性,有助于针对性治疗。

Objective To explore the application of stone bacterial culture in the prevention and treatment of infection after ureteroscopic lithotripsy.Methods 161 patients with upper urinary calculi who underwent ureteroscopic lithotripsy in our hospital from May 2020 to September 2021 were selected.All patients were treated with preoperative urine culture and intraoperative stone culture.To analyze the therapeutic effect and safety of ureteroscopic lithotripsy;The levels of clinical indexes[C-reactive protein(CRP),procalcitonin(PCT),neutrophils]before and after operation,the positive rate of urine and stone culture and the difference of bacterial spectrum were compared,the risk factors of postoperative infectious complications were explored,and the correlation between infection and urine and stone culture was analyzed.Results 161 patients were hospitalized for 3-12 d,with an average of(5.47±1.56)d.The results of 2D plain films of 149 patients showed no obvious residue,the stone clearance rate was 92.55%,and the incidence of postoperative infectious complications was 16.15%.Compared with urinary bacterial culture,the positive rate of stone culture was significantly lower(P<0.05).Univariate and multivariate analysis showed that stone culture results,urine culture results and stone diameter were the risk factors affecting the total effective rate(P<0.05).The positive rates of stone culture and urine culture were significantly positively correlated with the incidence of postoperative infectious complications(P<0.05).ROC curve showed that the sensitivity,specificity and area under the curve were 80.8%,75.6%and 0.823 respectively.Conclusion Ureteroscopic lithotripsy has the characteristics of good curative effect and high safety,and combined with intraoperative stone bacterial culture can improve the accuracy of predicting postoperative infectious complications and contribute to targeted treatment.