输尿管软镜钬激光碎石术治疗上尿路结石近期疗效及术后院内感染相关因素分析  

Short-term curative effect of flexible ureteroscopic holmium laser lithotripsy on upper urinary tract stones and related factors of postoperative nosocomial infection

作　　者：焦志灵[1] 李路鹏 王连渠[1] 刘倩[1] Jiao Zhiling;Li Lupeng;Wang Lianqu;Liu Qian(The First Affiliated Hospital of Henan University,Kaifeng 475000,Henan,China)

机构地区：[1]河南大学第一附属医院,河南开封475001

出　　处：《临床心身疾病杂志》2021年第3期109-113,130,共6页Journal of Clinical Psychosomatic Diseases

基　　金：河南省医学科技攻关计划项目(编号201203082)。

摘　　要：目的探讨输尿管软镜钬激光碎石术治疗上尿路感染的近期疗效及术后院内感染的危险因素。方法收集127例行输尿管软镜钬激光碎石术治疗的上尿路结石患者的临床资料,依据患者术后是否发生院内感染分为感染组(n=25)与非感染组(n=102),应用单因素及多因素Logistic回归分析院内感染相关因素。结果入组患者结石清除率为94.5%,发生院内感染25例(19.7%),以泌尿系统感染(64.0%)为主,共培养菌株37株,以感染革兰阴性菌(73.0%)为主。感染组女性、合并糖尿病、肾结石、术前尿路感染、重度肾积水、肾盂内压>30 mmHg、手术时间≥60 min患者比例显著高于非感染组(P<0.05)。性别、合并糖尿病、尿路感染、肾积水程度、肾盂内压、手术时间为输尿管软镜钬激光碎石术后发生院内感染的危险因素(P<0.05或0.01)。结论输尿管软镜钬激光碎石术治疗上尿路结石患者效果显著,结石清除率高,女性、术前合并尿路感染、重度肾积水、肾内压较高、合并糖尿病、手术时间延长的上尿路结石患者术后有更高的院内感染风险,应给予相应干预措施。Objective To investigate the short-term curative effect of flexible ureteroscopic holmium laser lithotripsy on upper urinary tract stones and related factors of postoperative nosocomial infection.Methods The clinical data of 127 patients with upper urinary tract stones who underwent flexible ureteroscopic holmium laser lithotripsy was collected,and the patients were divided into infected group(n=25)and non-infected group(n=102)according to whether the patients had nosocomial infection after operation.Single factor and multivariate Logistic regression were used to analyze the related factors of nosocomial infection.Results The stone removal rate of the enrolled patients was 94.5%,25 cases(19.7%)had nosocomial infections,mainly urinary system infection(64.0%),37 strains were co-cultured,mainly infected with Gram-negative bacteria(73.0%).The proportion of female patients,complicated with diabetes,renal calculi,preoperative urinary tract infection,severe hydronephrosis,renal pelvic pressure greater than 30 mmHg,operation time greater than or equal to 60 min in infection group was significantly higher than that in non-infection group(P<0.05).Gender,diabetes mellitus,urinary tract infection,degree of hydronephrosis,renal pelvic pressure and operation time were risk factors for nosocomial infection after flexible ureteroscopic holmium laser lithotripsy(P<0.05 or 0.01).Conclusions Flexible ureteroscopic holmium laser lithotripsy is effective in the treatment of upper urinary tract calculi,with high stone clearance rate.Females,patients with urinary tract infection,severe hydronephrosis,high renal pressure, diabetes mellitus and prolonged operation time have higher risk of nosocomial infection after operation,so corresponding intervention measures should be given.

关 键 词：上尿路结石 输尿管软镜碎石术 钬激光 院内感染 危险因素 

分 类 号：R691.4[医药卫生—泌尿科学]