PCNL术前中段尿与术中肾盂尿和结石培养的相关性及术后SIRS的相关影响因素  

Correlation among preoperative midstream urine,renal pelvic urine and stone culture in PCNL and the influencing factors of the SIRS

作　　者：李声宏[1] 张军晖[1] 牛亦农[1] 田溪泉[1] 邢念增[1] 

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100020

出　　处：《临床泌尿外科杂志》2013年第12期912-914,917,共4页Journal of Clinical Urology

摘　　要：目的：探讨经皮肾镜取石术（PCNL）术前中段尿与术中肾盂尿和结石培养之间的关系及这三者的培养结果对术后治疗全身炎症反应综合征（SIRS）的指导意义．同时分析术后SIRS的相关影响因素。方法：选取2012年4月～2013年2月行PCNI。的上尿路结石患者64例。男34例，女30例，所有患者均行术前中段尿、术中肾盂尿及结石培养。同时对各项临床因素进行回归分析，明确与SIRS发生率之间的关系。结果：64例患者手术均顺利完成，其中术后发生SIRS的患者为21例。术前中段尿培养阳性率为26．6％，肾盂尿培养阳性率为17．2％，结石培养阳性率为37．5％。中段尿培养与肾盂尿、结石培养的结果存在一致性。在多元回归模型中，结石培养和鹿角形结石与术后SIRS的发生存在相关性。结论：常规的术前中段尿培养能够反映和预测术中肾盂尿及结石培养的结果。对于感染性结石及存在其他高危SIRS因素的患者，留取中段尿、肾盂尿及结石培养有助于术后针对性地应用抗生素。Objective： To investigate the correlation among preoperative midstream urine, renal pelvic urine and stone culture in pereutaneous nephrolithotomy （PCNL） and to study the influencing factors of systemic in- flammatory response syndrome （SIRS）. Method： From April 2012 to February 2013, 64 patients （34 males and 30 females） underwent PCNL. Preoperative midstream urine, intraoperative renal pelvic urine and stones speci mens were cultured. Regression analysis was done to identify clinical variables associated with SIRS. Result： PCNL of 64 cases were performed successfully. SIRS appeared in 21 cases postoperatively. The result of preopera- tive midstream urine culture was positive in 17 cases （26.6 %）, intraoperative renal pelvic urine culture was posi- tive in 11 cases （17.2%） and stone culture was positive in 24 cases （37.5%）. The consistency of the above re- suits were shown. In multiple regression analyses, stone culture and stag-horn calculi were significant prediction of SIRS postoperatively. Conclusion： Preoperative midstream urine culture could predict the results of intraopera rive renal pelvic urine and stone culture. The result of preoperative midstream urine, intraoperative renal pelvic u- rine and stone specimens culture could give directions for antibiotics using in patients at risk of SIRS, particularly those with stag-horn calculi or any other high risk factors.

关 键 词：经皮肾镜取石术 全身炎症反应综合征 肾盂尿 结石培养 

分 类 号：R692.4[医药卫生—泌尿科学]