不同类型输尿管软镜治疗上尿路结石及其并发尿源性脓毒血症的相关因素分析

Analisis of different types of flexible ureteroscope treating upper urinary calculi and the related factors of complicated urinary sepsis

目的:探讨不同类型的输尿管软镜治疗上尿路结石的效果及其并发尿源性脓毒血症的相关因素。方法:将上海青浦中医院收治的280例上尿路结石患者根据手术方式的不同分为研究组及对照组,每组140例。其中研究组采用电子输尿管软镜碎石治疗,对照组采用纤维输尿管软镜碎石治疗。比较两组的手术时间、住院时间、一次结石清除率及术后全身炎性反应综合征(SIRS)的发生情况,并对输尿管软镜治疗后并发尿源性脓毒血症的相关因素进行单因素和多因素分析。结果:研究组手术时间及一次结石清除率均显著优于对照组(P <0. 05),而两组的住院时间及术后SIRS发生率比较,差异无统计学意义(P> 0. 05)。单因素分析显示,与患者输尿管软镜并发尿源性脓毒血症相关的因素包括性别、结石CT值> 1 000 HU、尿培养、糖尿病及手术时间(均P <0. 05);经Logistic回归分析,发现女性、结石CT值> 1 000 HU、尿培养阳性、糖尿病及手术时间> 60 min是上尿路结石患者输尿管软镜术后并发尿源性脓毒血症的独立危险因素(均P <0. 05)。结论:电子输尿管软镜治疗上尿路结石的疗效更为显著。具有上尿路结石软镜术后并发尿源性脓毒血症的独立危险因素的高危患者是今后临床工作监控的重点。

Objective:To investigate the effects of different types of flexible ureteroscope on upper urinary calculi and the related factors of complicated urinary sepsis.Methods:Two hundred and eighty patients with upper urinary calculi admitted to Shanghai Qingpu Hospital of Traditional Chines Medicine were divided into the study group and the control group according to the difference of surgical methods,140 cases in each group.The study group was treated with digital flexible ureteroscope and the control group was treated with fiberoptic flexible ureteroscope.The operation time,hospital stay,primary stone clearance rate,and postoperative systemic inflammatory response syndrome(SIRS)were compared between the two groups.Results:The operation time and the clearance rate of primary stone in the study group were significantly better than those in the control group(P<0.05).There was no significant difference in the hospitalization time and the incidence of postoperative SIRS between the two groups(P>0.05).The univariate analysis found that the factors associated with ureteroscopy complicated by urinary sepsis included gender,calculus CT value>1 000 HU,urine culture positive,diabetes and operative time(P<0.05).The Logistic regression analysis showed that femininity,calculus CT value>1 000 HU,urine culture positive,diabetes and operation time(>60 min)were independent risk factors for urinogenic sepsis after ureteroscopy soft surgery in patients with upper urinary calculi(P<0.05).Conclusions:The efficacy of digital flexible ureteroscope in the treatment of upper urinary calculi is more significant.At the same time,the patients with the independent risk factors for urinary sepsis after upper urinary calculi soft surgery are the monitoring focus in the future clinical work.