Study on the treatment of postoperative infectious complications in HALF group of high-risk patients with tip-flexible negative pressure ureteral access sheath combined with disposable ureteroscope
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摘要: 目的 探讨在治疗HALF高危组上尿路结石患者的输尿管软镜碎石术(flexible ureteroscopic lithotripsy，FURL)术中应用前段可弯负压吸引鞘对术后感染相关并发症的影响。方法 回顾性分析2022年3月—2024年2月在郑州大学第二附属医院行FURL的128例HALF分组高危组上尿路结石患者的临床资料。根据术中是否使用负压鞘分为负压组(76例)和普通组(52例)。统计所有患者的基本资料、手术相关资料、术后感染相关并发症发生率等数据。比较2组患者术后感染指标、术后感染相关并发症发生率、术后住院时长、术后抗菌药物使用时长等。结果 所有手术均一期顺利完成。2组患者的临床基本资料差异无统计学意义。负压组手术时间[60.00(45.00，85.00) min]与普通组[55.00(40.00，73.75) min]比较差异无统计学意义。负压组术后发热1例(1.3%)、全身炎症反应综合征(systemic inflammatory response syndrome，SIRS)2例(2.6%)、术后住院时间(2.75±1.26) d、术后抗菌药物应用时间(2.42±1.10) d，均低于普通组的6例(11.5%)、7例(13.5%)、(3.75±2.10) d、(3.50±2.10) d，差异有统计学意义(P < 0.05)。结论 在FURL治疗HALF分组高危组患者术中应用前段可弯曲负压吸引鞘可以降低术后感染相关并发症发生率，提高手术的安全性，减少术后抗菌药物应用，节约医疗资源，缩短患者住院时长，促进患者术后恢复，降低患者住院成本。
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关键词:
- 前段可弯曲负压吸引鞘 /
- 输尿管软镜碎石术 /
- 术后感染 /
- 上尿路结石
Abstract: Objective To explore the effect of flexible ureteroscopic lithotripsy(FURL) with tip-flexible negative pressure ureteral access sheath on postoperative infectious complications in high risk group of HALF.Methods The clinical data of 128 patients with upper urinary calculi in high risk group of HALF who underwent FURL in the Second Affiliated Hospital of Zhengzhou University from March 2022 to February 2024 were retrospectively analyzed. Based on whether or not tip-flexible negative pressure ureteral access sheath was used during operation, the patients were divide into negative pressure group(76 cases) and normal group(52 cases). The basic data, surgical data and incidence of postoperative infectious complications of all patients were analyzed. Postoperative infection index, incidence rate of postoperative infectious complications, duration of postoperative hospitalization and duration of postoperative antibiotic use were compared between the two groups.Results All patients successfully completed the primary operation. There was no statistical difference in the basic clinical data between the two groups. There was no significant difference in operation time between the negative pressure group(60.00[45.00, 85.00] min) and the normal group(55.00[40.00, 73.75] min). There was one case of postoperative fever(1.3%) and two cases of systemic inflammatory response syndrome(2.6%) in the negative pressure group, while there were six cases of postoperative fever(11.5%) and seven cases of systemic inflammatory response syndrome(13.5%) in the conventional group. The postoperative hospital stay (2.75±1.26) days and the duration of antibiotic use (2.42±1.10) days in the negative pressure group were shorter than those in the conventional group(3.75±2.10) days and (3.50±2.10) days, respectively, with statistically significant differences(P < 0.05).Conclusion The use of tip-flexible negative pressure ureteral access sheath in the FURL treatment of the high-risk patients in the HALF group can reduce the incidence of postoperative infectious complications, improve the safety of the operation, reduce the use of postoperative antibiotics, conserve medical resources, shorten the length of hospital stay, promote postoperative recovery of patients, and reduce the cost of hospitalization for patients. -
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表 1 2组患者的基本资料比较
例(%)，X±S，M(Q1，Q3) 变量 负压组(76例) 普通组(52例) t/z/χ2 P值 年龄/岁 47.86±12.86 50.17±13.00 0.997 0.321 性别 1.076 0.300 男 64(84.2) 40(76.9) 女 12(15.8) 12(23.1) BMI/(kg/m2) 25.80±4.00 25.47±3.59 0.465 0.643 糖尿病 21(27.6) 15(28.8) 0.023 0.881 高血压 31(40.8) 18(34.6) 0.498 0.480 冠心病 3(3.9) 4(7.7) 0.838 0.360 术前尿亚硝酸盐阳性 2(2.6) 1(1.9) 0.000 1.000 术前肌酐/(μmol/L) 76.00(67.00，99.00) 76.00(61.50，96.50) 0.776 0.437 结石侧别 0.169 0.919 左侧 35(46.1) 25(48.1) 右侧 26(34.2) 16(30.8) 双侧 15(19.7) 11(21.1) 结石位置 4.936 0.085 肾 24(31.6) 10(19.2) 输尿管上段 11(14.5) 15(28.8) 肾、输尿管上段 41(53.9) 27(51.9) 结石类型 0.000 1.000 草酸钙结石 71(93.4) 49(94.2) 感染性结石 5(6.6) 3(5.8) 结石合径/mm 28.15(20.25，41.08) 25.50(14.25，34.75) 1.730 0.084 结石CT值/HU 1 014.93±277.01 997.33±311.58 0.336 0.738 肾积水分度 4.828 0.185 无 15(19.7) 4(7.7) 轻度 15(19.7) 8(15.4) 中度 36(47.4) 33(63.5) 重度 10(13.2) 7(13.5) 
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表 2 2组手术资料比较
例(%)，M(Q1，Q3) 变量 负压组(76例) 普通组(52例) z/χ2 P值 手术时间/min 60.00(45.00，85.00) 55.00(40.00，73.75) 0.914 0.361 术后体温/℃ 37.00(36.80，37.30) 37.20(36.90，37.80) 1.786 0.074 术后即刻清石 62(81.6) 33(63.5) 5.296 0.021 术后肌酐/(μmol/L) 76.00(66.25，98.75) 73.50(62.00，95.00) 1.320 0.187
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表 3 术后相关资料及感染相关并发症比较
例(%)，X±S，M(Q1，Q3) 变量 负压组(76例) 普通组(52例) z/t/χ2 P值 术后白细胞计数/(×109/L) 6.67(5.18，8.68) 7.80(4.88，12.54) 1.533 0.125 术后住院时间/d 2.75±1.26 3.75±2.10 3.073 0.003 术后抗菌药物使用时间/d 2.42±1.12 3.50±2.10 3.388 0.001 血常规异常 10(13.2) 20(38.5) 4.716 0.030 发热 1(1.3) 6(11.5) 4.420 0.036 SIRS 2(2.6) 7(13.5) 4.007 0.045 脓毒症休克 0(0) 1(1.9) - -
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[1] Jiang PB, Xie L, Arada R, et al. Qualitative review of clinical guidelines for medical and surgical management of urolithiasis: consensus and controversy 2020[J]. J Urol, 2021, 205(4): 999-1008. doi: 10.1097/JU.0000000000001478
[2] Dybowski B, Bres-Niewada E, Rzeszutko M, et al. Risk factors for infectious complications after retrograde intrarenal surgery-a systematic review and narrative synthesis[J]. Cent European J Urol, 2021, 74(3): 437-445.
[3] 乔庐东, 陈山, 马小军, 等. 上尿路结石患者围手术期抗菌药物应用的专家意见[J]. 中华泌尿外科杂志, 2017, 38(9): 641-643.
[4] 上尿路结石围手术期感染控制及抗菌药物应用专家意见编写组. 上尿路结石患者围手术期感染控制及抗菌药物应用专家意见(2023版)[J]. 中华泌尿外科杂志, 2023, 44(7): 481-485.
[5] 中华医学会泌尿外科学分会结石学组, 中国泌尿系结石联盟, 陈斌, 等. 负压技术在输尿管镜治疗上尿路结石应用的中国专家共识(2023年)[J]. 临床泌尿外科杂志, 2023, 38(8): 565-568. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2023.08.001
[6] Qian XY, Liu CQ, Hong SY, et al. Application of suctioning ureteral access sheath during flexible ureteroscopy for renal stones decreases the risk of postoperative systemic inflammatory response syndrome[J]. Int J Clin Pract, 2022, 2022: 9354714.
[7] 黄健, 张旭. 中国泌尿外科和男科疾病诊断治疗指南: 2022版[M]. 北京: 科学出版社, 2022.
[8] 刘一凡, 刘威, 张旭辉, 等. 输尿管软镜联合负压吸引工作鞘治疗不同肾积水程度下肾结石患者的疗效分析[J]. 国际泌尿系统杂志, 2024, 44(1): 64-68.
[9] Liu MH, Zhu ZW, Cui Y, et al. The value of procalcitonin for predicting urosepsis after mini-percutaneous nephrolithotomy or flexible ureteroscopy based on different organisms[J]. World J Urol, 2022, 40(2): 529-535. doi: 10.1007/s00345-021-03845-9
[10] 张加桥, 余虓, 姚炜敏, 等. 使用负压清石鞘对经皮肾镜碎石术术后感染相关并发症的影响[J]. 现代泌尿外科杂志, 2020, 25(2): 156-158, 161.
[11] Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock(sepsis-3)[J]. JAMA, 2016, 315(8): 801-810. doi: 10.1001/jama.2016.0287
[12] Baş O, Tuygun C, Dede O, et al. Factors affecting complication rates of retrograde flexible ureterorenoscopy: analysis of 1571 procedures-a single-center experience[J]. World J Urol, 2017, 35(5): 819-826.
[13] Zhang H, Jiang T, Gao R, et al. Risk factors of infectious complications after retrograde intrarenal surgery: a retrospective clinical analysis[J]. J Int Med Res, 2020, 48(9): 300060520956833.
[14] Ma YC, Jian ZY, Yuan C, et al. Risk factors of infectious complications after ureteroscopy: a systematic review and meta-analysis based on adjusted effect estimate[J]. Surg Infect(Larchmt), 2020, 21(10): 811-822.
[15] Tan D, Wu FH, Huo WQ. Clinical characteristics and risk factors of systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy[J]. Arch Esp Urol, 2022, 75(7): 618-623.
[16] 王硕, 时新宇, 王晓甫, 等. 术前尿培养阴性患者输尿管软镜碎石术后发热的危险因素分析及预测发热列线图模型的构建[J]. 中华泌尿外科杂志, 2024, 45(3): 202-207.
[17] Matsumoto M, Shigemura K, Yamamichi F, et al. Prevention of infectious complication and its risk factors after urological procedures of the upper urinary tract[J]. Urol Int, 2012, 88(1): 43-47.
[18] 吴小将, 田文俊, 郑达闻, 等. 可弯曲负压吸引鞘联合输尿管软镜钬激光碎石术治疗直径2~3 cm上尿路结石的临床研究[J]. 中华全科医学, 2023, 21(9): 1516-1519.
[19] 林剑峰, 叶志彬, 涂建平, 等. 可弯曲负压吸引鞘与常规鞘联合一次性输尿管软镜治疗上尿路结石的疗效比较[J]. 中国微创外科杂志, 2023, 23(9): 652-656.
[20] Zhu ZW, Cui Y, Zeng F, et al. Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones[J]. World J Urol, 2019, 37(5): 921-929.
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