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摘要: 目的：探讨肾结石患者行经皮肾镜取石术（PCNL）后发热的危险因素。方法：回顾性分析2014年1月~2017年6月我院收治的183例因肾结石行PCNL患者的临床资料，其中男97例，女86例，平均年龄（53.6±13.1）岁。术前尿WBC异常152例，中段尿培养阳性36例。对围手术期可能导致PCNL术后发热的因素进行单因素和多因素Logistic回归分析。结果：183例患者手术均顺利完成，平均手术时间（114.3±52.2） min，平均估计出血量（41.1±63.8） ml，术后结石残留82例（44.8%），术后发热29例（15.8%）。单因素Logistic回归分析发现慢性肾脏病（CKD）分期、尿WBC计数、术后结石残留为术后发热的危险因素，而年龄、性别、肾积水程度、中段尿培养阳性、糖尿病、手术时间、术中估计出血量、ASA分级、S.T.O.N.E.评分及Guy's评分与术后发热无关。多因素Logistic回归分析结果表明术后结石残留为PCNL术后发热的独立危险因素（OR=2.486，95% CI：1.169~5.780，P=0.034）。结论：术后结石残留是预测PCNL术后发热的独立危险因素。Abstract: Objective: To evaluate the risk factors for fever after percutaneous nephrolithotomy (PCNL).Method: Between January 2014 and June 2017, 183 PCNLs were performed at our hospital.The risk factors for fever were evaluated by a retrospective chart review.There were 97 men and 86 women, whose mean age was (53.6±13.1) years old.One hundred and fifty-two patients had abnormal WBC count in urine analysis and 36 had positive midstream urine culture preoperatively.Regression analysis was performed to determine the risk factors for fever after PCNL.Result: All 183 PCNLs were successfully completed, with average operation time (114.3±52.2) min and mean blood loss (41.1±63.8) ml.The overall stone-residual rate was 44.8% and 29 patients (15.8%) experienced fever after PCNL.Univariate regression analysis showed that chronic kidney disease (CKD) stages, WBC count of urine analysis, incomplete stone extraction were risk factors for fever after PCNL, but the age, gender, degree of hydronephrosis, positive urine culture, diabetes, operation time, mean blood loss, ASA classification, S.T.O.N.E.score and the Guy's grade were not significantly associated with postoperative fever.Multivariate regression analysis revealed that only incomplete stone extraction was an independent risk factor for the development of fever after PCNL.Conclusion: Incomplete stone extraction is a major risk factor for the development of fever after PCNL.
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Key words:
- renal calculus /
- percutaneous nephrolithotomy /
- fever /
- risk factor
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