输尿管软镜术后SIRS发生的危险因素分析

Risk factors of SIRS following retrograde intrarenal surgery in the treatment of urolithiasis

摘要:

目的：探讨逆行输尿管软镜钬激光碎石术（retrograde intrarenal surgery，RIRS）治疗肾及输尿管上段结石术后发生全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）的危险因素。方法：回顾性分析2013年11月至2016年8月因肾及输尿管上段结石接受输尿管软镜治疗的890例患者的临床资料。将患者分为SIRS组（n=37）和Non-SIRS组（n=853），通过单因素logistic回归分析和多因素logistic回归分析以确定RIRS术后发生SIRS的危险因素。结果：在890例患者（男性584例，女性306例）中，4.2%（37/890）术后出现SIRS。在单因素分析中，SIRS与术前使用免疫抑制剂、术前因结石发热、术前中段尿培养、术前尿白细胞计数、术中尿液浑浊、脓苔（P<0.05）等因素显著相关，与患者性别、年龄、体质量指数、糖尿病、高血压、术前血肌酐水平、手术时间、结石大小等因素无显著相关性（P>0.05）；在多因素回顾分析中，术前因结石发热（P=0.014，OR=4.228，95%CI=1.341～13.331）或术前尿白细胞计数≥544个/mL（P<0.001，OR=5.075，95%CI=2.350～10.959）或术中尿液浑浊、脓苔（P<0.001，OR=8.373，95%CI=2.773～25.279）与术后SIRS发生显著相关。结论：术前因结石发热、术前尿白细胞计数、术中尿液浑浊、脓苔为输尿管软镜碎石术后SIRS发生的危险因素。术前应予以充分治疗，必要时分期手术。

Abstract:

Objective：To investigate the risk factors of systemic inflammatory response syndrome（SIRS） after retrograde intrarenal surgery（RIRS） with holmium laser lithotripsy in patients with renal or/and proximal ureteral calculi. Methods：The clinical data of 890 patients who underwent RIRS with holmium laser lithotripsy for renal or/and proximal ureteral calculi were retrospectively ana－lyzed from November 2013 to August 2016. The patients were divided into two groups，and the odds ratio（OR） and the 95% confi－dence interval（95%CI） were calculated by univariate and multivariate logistic regression analysis to determine the risk factors after RIRS. Results：In 890 patients（male 584，female 306），SIRS（37/890） was found in all of the 4.2% patients. In univariate analysis，SIRS was significantly related with the use of immuno－suppressive agents，a recent history of stone ralated fever，pre－operative positive urine culture，preoperative WBCs in urine，and urine pus during operation（P<0.05）. SIRS was not correlated with gender，age，BMI，hypertension，diabetes mellitus before opera－tion，the serum creatinine level，operation time，and stone size（P>0.05）. Multivariate analysis further confirmed that SIRS was signifi－cantly associated with a recent history of stone related fever（P=0.014，OR=4.22，95%CI=1.341 to 13.331），preoperativeurine WBCs increase（≥544/mL）（P<0.001，OR=5.075，95%CI=2.350 to 10.959），intraoperative urine pus（P<0.001，OR=8.373，95%CI=2.773 to 25.279）. Conclusion：A recent history of stone related fever，preoperative WBCs in urine，intraoperative urine pus are risk factors for SIRS after RIRS. The risks should be paid for full attention，controlled and treated before operation，if necessary，surgical staging should be needed.