Wang Zhaohui,Zhao Yaowang.Risk factors for urinary tract infection after pyeloureteroplasty in children[J].Journal of Clinical Pediatric Surgery,2024,(04):310-314.[doi:10.3760/cma.j.cn101785-202403060-003]
也谈儿童肾盂输尿管连接处梗阻手术后泌尿系感染的影响因素
- Title:
- Risk factors for urinary tract infection after pyeloureteroplasty in children
- Keywords:
- Ureteropelvic Junction Obstruction; Urdogic Surgical Procedurse; Postoperative Complications; Urinary Tract Infection; Risk Factors; Child
- 摘要:
- 肾盂输尿管连接处梗阻(ureteropelvic junction obstruction,UPJO)是导致儿童病理性肾积水的最常见原因。目前,腹腔镜下肾盂输尿管成形术(laparoscopic pyeloplasty,LP)已逐渐成为UPJO的首选手术方式。泌尿系感染(urinary tract infection,UTI) 是肾盂输尿管成形术后常见早期并发症之一。UTI可导致病程延长,严重者甚至可诱发尿源性脓毒血症;也可导致术后吻合口再狭窄,影响手术成功率。本文旨在分析和阐述儿童UPJO手术后UTI的影响因素,以期提高临床对于UPJO手术后UTI的认识,进而采取相应措施预防UTI的发生,缩短UTI病程,提高手术成功率。
- Abstract:
- Ureteropelvic junction obstruction (UPJO) is the most common cause of pathological hydronephrosis in children.Laparoscopic pyeloplasty (LP) has gradually become a preferred surgical option for UPJO.As one of the common early complications of LP,urinary tract infection (UTI) prolongs the course of the disease and even induce lethal urogenic sepsis,in severe cases.At the same time,it may lead to postoperative restenosis of the anastomosis and affect the success rate of the operation.This reviews summarized the risk factors for UTI after LP in children with UPJO,in order to improve the understanding of urdogists.Corresponding interventions may prevent the occurrence of UTI,shorten the course of UTI,and thus improve the success rate of operation.
参考文献/References:
[1] Vemulakonda VM.Ureteropelvic junction obstruction:diagnosis and management[J].Curr Opin Pediatr,2021,33(2):227-234.DOI:10.1097/MOP.0000000000000994.
[2] Riedmiller H,Androulakakis P,Beurton D,et al.EAU guidelines on paediatric urology[J].Eur Urol,2001,40(5):589-599.DOI:10.1159/000049841.
[3] Paraboschi I,Jannello L,Mantica G,et al.Outcomes and costs analysis of externalized pyeloUreteral versus internal Double-J ureteral stents after paediatric laparoscopic Anderson-Hynes pyeloplasty[J].J Pediatr Urol,2021,17(2):232.e1-232.e7.DOI:10.1016/j.jpurol.2020.12.006.
[4] Chandrasekharam VVS.Laparoscopic pyeloplasty in infants:selective referencing and citation bias[J].World J Urol,2023,41(8):2297-2298.DOI:10.1007/s00345-023-04488-8.
[5] Chenoweth CE.Urinary tract infections:2021 update[J].Infect Dis Clin North Am,2021,35(4):857-870.DOI:10.1016/j.idc.2021.08.003.
[6] Ceyhan E,Ileri F,Ceylan T,et al.Predictors of recurrence and complications in pediatric pyeloplasty[J].Urology,2019,126:187-191.DOI:10.1016/j.urology.2019.01.014.
[7] He YZ,Song HC,Liu P,et al.Primary laparoscopic pyeloplasty in children:a single-center experience of 279 patients and analysis of possible factors affecting complications[J].J Pediatr Urol,2020,16(3):331.e1-331.e11.DOI:10.1016/j.jpurol.2020.03.028.
[8] Sturm RM,Chandrasekar T,Durbin-Johnson B,et al.Urinary diversion during and after pediatric pyeloplasty:a population based analysis of more than 2000 patients[J].J Urol,2014,192(1):214-219.DOI:10.1016/j.juro.2014.01.089.
[9] Wang HY,Hao CS,Bai DS.Risk factors of urinary tract infection in pediatric patients with ureteropelvic junction obstruction after primary unilateral pyeloplasty[J].Comput Math Methods Med,2022,2022:3482450.DOI:10.1155/2022/3482450.
[10] 徐宏业,张玲玲,杜国强,等.腹腔镜肾盂成形术后双J管相关泌尿系统感染的危险因素分析[J].临床小儿外科杂志,2021,20(4):334-339.DOI:10.12260/lcxewkzz.2021.04.007. Xu HY,Zhang LL,Du GQ,et al.Analysis of risk factors of double J stent-related infection after laparoscopic pyeloplasty[J].J Clin Ped Sur,2021,20(4):334-339.DOI:10.12260/lcxewkzz.2021.04.007.
[11] Chen L,Baker MD.Racial and ethnic differences in the rates of urinary tract infections in febrile infants in the emergency department[J].Pediatr Emerg Care,2006,22(7):485-487.DOI:10.1097/01.pec.0000226872.31501.d0.
[12] Wang JF,Cao Y,Zhang L,et al.Pathogen distribution and risk factors for urinary tract infection in infants and young children with retained double-J catheters[J].J Int Med Res,2021,49(5):3000605211012379.DOI:10.1177/03000605211012379.
[13] 柴红超,周云,王静茹,等.肾积水患儿并发症危险因素Logistic回归分析[J].临床军医杂志,2019,47(11):1268-1269,1275.DOI:10.16680/j.1671-3826.2019.11.40. Chai HC,Zhou Y,Wang JR,et al.Logistic regression analysis of risk factors for complications in children with hydronephrosis[J].Clin J Med Off,2019,47(11):1268-1269,1275.DOI:10.16680/j.1671-3826.2019.11.40.
[14] [JP2] 柏凯平,张志远,邢晓宇,等.肾盂输尿管连接处狭窄患儿术后尿路感染的危险因素[J].现代泌尿外科杂志,2022,27(1):16-19,29.DOI:10.3969/j.issn.1009-8291.2022.01.003.[JP] Bai KP,Zhang ZY,Xing XY,et al.Risk factors of postoperative urinary tract infection in children with ureteropelvic junction obstruction after pyeloplasty[J].J Mod Urol,2022,27(1):16-19,29.DOI:10.3969/j.issn.1009-8291.2022.01.003.
[15] Tsai YL,Seow KM,Yieh CH,et al.Comparative study of conservative and surgical management for symptomatic moderate and severe hydronephrosis in pregnancy:a prospective randomized study[J].Acta Obstet Gynecol Scand,2007,86(9):1047-1050.DOI:10.1080/00016340701416713.
[16] Kong XP,Li ZP,Li MJ,et al.Comparison of drainage methods after pyeloplasty in children:a 14-year study[J].Front Pediatr,2021,9:779614.DOI:10.3389/fped.2021.779614.
[17] Sarhan O,Al Awwad A,Al Otay A,et al.Comparison between internal double J and external pyeloureteral stents in open pediatric pyeloplasty:a multicenter study[J].J Pediatr Urol,2021,17(4):511.e1-511.e7.DOI:10.1016/j.jpurol.2021.03.027.
[18] Abedi AR,Dargahi M,Hosseini SJ.Misplacement of DJ stent into inferior vena cava in a patient with retroperitoneal fibrosis,a case report[J].Urol Case Rep,2021,38:101650.DOI:10.1016/j.eucr.2021.101650.
[19] Liu X,Huang CG,Guo Y,et al.Comparison of DJ stented,external stented and stent-less procedures for pediatric pyeloplasty:a network meta-analysis[J].Int J Surg,2019,68:126-133.DOI:10.1016/j.ijsu.2019.07.001.
[20] Chu DI,Shrivastava D,Van Batavia JP,et al.Outcomes of externalized pyeloureteral versus internal ureteral stent in pediatric robotic-assisted laparoscopic pyeloplasty[J].J Pediatr Urol,2018,14(5):450.e1-450.e6.DOI:10.1016/j.jpurol.2018.04.012.
[21] 宗焕涛,刘璟芃,王涛,等.带尾线输尿管支架管短时间留置在输尿管软镜手术中的应用[J].中国临床医生杂志,2024,52(3):326-328.DOI:10.3969/j.issn.2095-8552.2024.03.019. Zong HT,Liu JP,Wang T,et al.Application of short-term indwelling ureteral stent tube with tail line during flexible ureteroscopy surgery[J].Chin J Clin,2024,52(3):326-328.DOI:10.3969/j.issn.2095-8552.2024.03.019.
[22] Ko?vara R,Sedlá?ek J,Drlík M,et al.Unstented laparoscopic pyeloplasty in young children (1-5 years old):a comparison with a repair using double-J stent or transanastomotic externalized stent[J].J Pediatr Urol,2014,10(6):1153-1159.DOI:10.1016/j.jpurol.2014.04.017.
[23] Ninan GK,Sinha C,Patel R,et al.Dismembered pyeloplasty using double’J’stent in infants and children[J].Pediatr Surg Int,2009,25(2):191-194.DOI:10.1007/s00383-008-2313-7.
[24] 王媛媛,宋翠萍,张海洋,等.先天性肾盂输尿管连接处梗阻手术后引流方式探讨[J].临床小儿外科杂志,2017,16(5):455-458,495.DOI:10.3969/j.issn.1671-6353.2017.05.009. Wang YY,Song CP,Zhang HY,et al.Comparative analysis of urine drainage in congenital hydronephrosis[J].J Clin Ped Sur,2017,16(5):455-458,495.DOI:10.3969/j.issn.1671-6353.2017.05.009.
[25] 李丹,吴轶璇,丁雪芹,等.小儿肾盂输尿管成形术后尿路感染与置管方式及时间的关联性分析[J].中华医院感染学杂志,2018,28(15):2381-2384,2393.DOI:10.11816/cn.ni.2018-172983. Li D,Wu YX,Ding XQ,et al.Association between postoperative urinary tract infections and the catheterization placement and time in the isolated ureteropelvic junction angioplasty of the children[J].Chin J Nosocomiol,2018,28(15):2381-2384,2393.DOI:10.11816/cn.ni.2018-172983.
[26] Barnum T,Tatebe LC,Halverson AL,et al.Outcomes associated with insertion of indwelling urinary catheters by medical students in the operating room following implementation of a simulation-based curriculum[J].Acad Med,2020,95(3):435-441.DOI:10.1097/ACM.0000000000003052.
[27] Islek A,Güven AG,Koyun M,et al.Probability of urinary tract infection in infants with ureteropelvic junction obstruction:is antibacterial prophylaxis really needed?[J].Pediatr Nephrol,2011,26(10):1837-1841.DOI:10.1007/s00467-011-1889-7.
[28] Williams G,Lee A,Craig J.Antibiotics for the prevention of urinary tract infection in children:a systematic review of randomized controlled trials[J].J Pediatr (Rio J),2001,138(6):868-874.DOI:10.1067/mpd.2001.113785.
[29] 张晨捷,张一帆,李龙,等.年龄对肾盂成形术后行双J管引流患儿围术期泌尿系感染的影响分析[J].北京医学,2021,43(7):601-603,607.DOI:10.15932/j.0253-9713.2021.07.003. Zhang CJ,Zhang YF,Li L,et al.Influence of age on perioperative urinary tract infection in children with double J tube drainage after laparoscopic pyeloplasty[J].Beijing Med J,2021,43(7):601-603,607.DOI:10.15932/j.0253-9713.2021.07.003.
[30] Rodríguez-Lozano J,de Malet A,Cano ME,et al.Antimicrobial susceptibility of microorganisms that cause urinary tract infections in pediatric patients[J].Enferm Infecc Microbiol Clin (Engl Ed),2018,36(7):417-422.DOI:10.1016/j.eimc.2017.08.003.
[31] 中华医学会小儿外科学分会泌尿外科学组.儿童原发性膀胱输尿管反流专家共识[J].临床小儿外科杂志,2019,18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002. Group of Pediatric urology,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Management of Primary Vesicoureteral Reflux in Children[J].J Clin Ped Sur,2019,18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002.
[32] Gnech M,Hoen L,Zachou A,et al.Update and summary of the European Association of Urology/European Society of Paediatric Urology Paediatric guidelines on vesicoureteral reflux in children[J].Eur Urol,2024,85(5):433-442.DOI:10.1016/j.eururo.2023.12.005.
[33] Rodríguez AH,Avilés-Jurado FX,Díaz E,et al.Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza:a CHAID decision-tree analysis[J].J Infect,2016,72(2):143-151.DOI:10.1016/j.jinf.2015.11.007.
[34] Paudel R,Dogra P,Montgomery-Yates AA,et al.Procalcitonin:a promising tool or just another overhyped test?[J].Int J Med Sci,2020,17(3):332-337.DOI:10.7150/ijms.39367.
[35] Cui N,Zhang YY,Sun T,et al.Utilizing procalcitonin,C-reactive protein,and serum amyloid A in combination for diagnosing sepsis due to urinary tract infection[J/OL].Int Urol Nephrol,2024.https://doi.org/10.1007/s11255-024-03959-0.DOI:10.1007/s11255-024-03959-0.
[36] 中华医学会儿科学分会医院感染管理与控制专业委员会.血清降钙素原检测在儿童感染性疾病中的临床应用专家共识[J].中华儿科杂志,2019,57(1):9-15.DOI:10.3760/cma.j.issn.0578-1310.2019.01.005. The Special Committee of Hospital Infection Management and Control,Society of Pediatrics,Chinese Medical Association:Expert Consensus on Clinical Application of Serum Procalcitonin for Pediatric Infectious Disease[J].Chin J Pediatr,2019,57(1):9-15.DOI:10.3760/cma.j.issn.0578-1310.2019.01.005.
[37] 颜冰,孙毅海,何文军,等.炎性因子检测与肾盂输尿管连接处梗阻手术治疗的临床研究[J].中国医药导报,2020,17(9):65-68. Yan B,Sun YH,He WJ,et al.Clinical study on detection of inflammatory factors and surgical treatment of ureteropelvic junction obstruction ureteral junction[J].China Med Herald,2020,17(9):65-68.
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备注/Memo
收稿日期:2024-04-01。
基金项目:湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017)
通讯作者:赵夭望,Email:yw508@sina.com