输尿管上段结石患者行日间输尿管软镜下钬激光碎石术术后感染及危险因素分析

Analysis of postoperative infection incidence and risk factors after daytime flexible endoscopic holmium laser lithotripsy for upper ureteral calculi

目的分析输尿管上段结石患者行日间输尿管软镜下钬激光碎石(RIRS)术引发术后感染发生率及其危险因素。方法回顾性选取2019年7月至2023年3月在徐州市中医院接受日间RIRS手术治疗的300例输尿管上段结石患者作为研究对象,术后记录患者的感染发生率,根据术后感染情况将患者分为感染组和未感染组。对比两组患者的性别、年龄、体重指数、病程、结石直径、结石位置、合并疾病、术前有无尿路感染、肾积水程度及手术时间;并建立多因素Logistic模型,分析导致日间RIRS术后感染的独立危险因素,同时对RIRS术后感染患者开展病原菌培养。结果300例患者术后感染发生率为18.67%。感染组年龄≥60岁、合并糖尿病、术前有尿路感染、重度肾积水、手术时间≥90 min患者比率分别为71.43%、71.43%、75.00%、85.71%、66.07%,均高于未感染组(23.77%、27.87%、26.64%、28.69%、37.70%),差异均有统计学意义(P<0.05)。单因素分析结果显示,合并疾病、术前尿路感染、肾积水程度、手术时间均为RIRS术后感染的影响因素(P<0.05)。多因素Logistic分析结果显示,合并糖尿病、术前有尿路感染、重度肾积水、手术时间≥90 min均为RIRS术后感染的独立危险因素(P<0.05)。56例日间RIRS术后感染患者共培养出86株病原菌,革兰阴性菌62.79%,革兰阳性菌32.56%,真菌4.65%。结论术前有尿路感染、合并糖尿病、重度肾积水等输尿管上段结石患者经日间RIRS手术治疗后引发术后感染的风险更高,应加强预防干预。

Objective To analyze the incidence of postoperative infection and the risk factors of daytime soft ureteroscopic holmium laser lithotripsy(RIRS)in patients with upper ureteral stones.Methods This study was a retrospective analysis,and 300 patients with upper ureteral stones who underwent daytime RIRS surgical treatment at Xuzhou City Hospital of Traditional Chinese Medicine from July 2019 to March 2023 were selected as the study subjects,and the incidence of infection were recorded in the patients after the operation,and the patients were divided into the infected group and the uninfected group according to the postoperative infection.The gender,age,body mass index,disease duration,stone diameter,stone location,co-morbidities,preoperative presence of urinary tract infection,degree of hydronephrosis,and operation time of the patients in the two groups were compared.Multifactorial Logistic model were set up to analyze the independent risk factors leading to postoperative infections after ambulatory RIRS,and pathogenic bacterial cultures were carried out on the patients with postoperative RIRS infections.Results The rates of patients with age≥60 years,diabetes,preoperative urinary tract infection,severe hydronephrosis,and operation time≥90 min in the infected group were 71.43%,71.43%,75.00%,85.71%,66.07%,respectively,which were higher than those in the uninfected group(23.77%,27.87%,26.64%,28.69%,37.70%),the differences were statistically significant(P<0.05).The results of univariate analysis showed that combined disease,preoperative urinary tract infection,degree of hydronephrosis,and operation time were all influencing factors of infection after RIRS(P<0.05).The results of multivariate Logistic-analysis showed that diabetes,preoperative urinary tract infection,severe hydronephrosis and 90 min were all independent risk factors for infection after RIRS(P<0.05).A total of 86 pathogenic bacteria were cultured in 56 infected patients after daytime RIRS,and the proportion of gram-negative bacteria,gram-positive bacteria and fungi were 62.79%,32.56%and 4.65%,respectively.Conclusion Patients with upper ureteral calculi who had preoperative urinary tract infection,diabetes,severe hydronephrosis,etc.have a higher risk of postoperative infection after daytime RIRS surgery,and preventive interventions should be strengthened.