Fang Wenjuan,Chen Pengyu,Liu Xiaodong,et al.Risk factors for postoperative urinary tract infections in children with primary obstructive megaureter[J].Journal of Clinical Pediatric Surgery,2024,(04):341-347.[doi:10.3760/cma.j.cn101785-202403060-008]
原发性梗阻性巨输尿管症患儿术后尿路感染的危险因素分析
- Title:
- Risk factors for postoperative urinary tract infections in children with primary obstructive megaureter
- 关键词:
- 原发性梗阻性巨输尿管; 输尿管梗阻; 泌尿系感染; 危险因素; 儿童
- Keywords:
- Primary Obstructive Megaureter; Ureteral Obstruction; Urinary Tract Infections; Risk Factors; Child
- 摘要:
- 目的 探讨原发性梗阻性巨输尿管症患儿术后发生尿路感染的危险因素。 方法 回顾性分析2015年1月至2023年2月深圳市儿童医院泌尿外科收治的146例原发性梗阻性巨输尿管症患儿临床资料,其中男97例、女49例;左侧89例,右侧40例,双侧17例;年龄1个月至17岁,中位年龄1岁11个月。根据术后尿培养结果分为感染组(35例)和非感染组(111例)。收集两组患儿手术时间、手术方式、肾积水程度、输尿管宽度、术前血液学参数、术前尿常规白细胞计数、术后尿常规及尿培养结果以及是否留置双J管、尿管、膀胱造瘘管等资料,采用单因素分析、多因素Logistic回归分析原发性梗阻性巨输尿管症患儿术后发生尿路感染的危险因素。 结果 单因素Logistic回归分析结果显示:年龄≤1岁、术前尿常规白细胞计数>5个/高倍镜视野(high power field,HPF)、肾积水程度>3级是原发性梗阻性巨输尿管症患儿术后发生尿路感染的危险因素(P<0.05)。多因素Logistic回归分析结果显示:年龄≤1岁患儿术后发生尿路感染的风险是年龄>1岁患儿的3.462倍(OR=3.462,95%CI:1.245~9.629,P=0.017),术前尿常规白细胞计数>5个/HPF的患儿术后发生尿路感染的风险是术前尿常规白细胞计数≤5个/HPF患儿的5.451倍(OR=5.451,95%CI:2.277~13.045,P＜0.001),肾积水程度>3级的患儿术后发生尿路感染的风险是肾积水程度≤3级患儿的5.473倍(OR=5.473,95%CI:1.135~26.390,P=0.034)。 结论 年龄≤1岁、术前尿常规白细胞计数>5个/HPF以及合并严重肾积水的原发性梗阻性巨输尿管症患儿更易发生术后尿路感染。
- Abstract:
- Objective To explore the risk factors for postoperative urinary tract infections (UTIs) in children of primary obstructive megaureter (POM). Methods From January 2015 to February 2023,retrospective analysis was performed for the relevant clinical data of 146 POM children.There were 97 boys and 49 girls with a median age of 23(1-17) month.The involved side was left (n=89),right (n=40) and bilateral (n=17).According to the results of postoperative urinary culture,they were assigned into two groups of infected (n=35) and non-infected (n=111).Operative duration,surgical approach,severity of hydronephrosis,ureteral width,preoperative hematological parameters,leucocyte count of preoperative urine routine,postoperative urinary routine/culture,double J tubing or not,urinary catheterization and bladder fistulas were recorded.Statistical analysis was performed for risk factors for postoperative UTIs. Results The results of univariate Logistic regression analysis indicated that age ≤1 year,leucocyte count of preoperative urine routine >5/HPF and severity of hydronephrosis >3 were risk factors for postoperative UTIs (P<0.05).The results of multivariate Logistic regression analysis revealed that the risk of postoperative UTIs in children aged ≤1 year was 3.462 folds higher than that in those aged >1 year (OR=3.462,95%CI:1.245-9.629,P=0.017).The risk of postoperative UTIs in children with leucocyte count of preoperative urine routine >5/HPF was 5.451 folds higher than that those with leucocyte count of preoperative urine routine ≤5/HPF (OR=5.451,95%CI:2.227-13.045,P<0.001).The risk of postoperative UTIs in children with hydronephrosis >grade Ⅲ was 5.473 folds higher than that in those with hydronephrosis ≤ grade Ⅲ(OR=5.473,95%CI:1.135-26.390,P=0.034). Conclusions Young POM children with leucocyte count of preoperative urine routine >5/HPF are more prone to postoperative UTIs.
参考文献/References:
[1] Ibrahimi A,Ziani I.Primary obstructive megaureter[J].Pan Afr Med J,2020,37:296.DOI:10.11604/pamj.2020.37.296.26867.
[2] Lopez M,Perez-Etchepare E,Bustangi N,et al.Laparoscopic extravesical reimplantation in children with primary obstructive megaureter[J].J Laparoendosc Adv Surg Tech A,2023,33(7):713-718.DOI:10.1089/lap.2019.0396.
[3] Ripatti L,Viljamaa HR,Suihko A,et al.High-pressure balloon dilatation of primary obstructive megaureter in children:a systematic review[J].BMC Urol,2023,23(1):30.DOI:10.1186/s12894-023-01199-5.
[4] 陈鹏宇,李守林.儿童原发性巨输尿管症的诊疗现状[J].中华小儿外科杂志,2023,44(2):182-188.DOI:10.3760/cma.j.cn421158-20211109-00546. Chen PY,Li SL.Current status of diagnosing and managing primary megaureter in children[J].Chin J Pediatr Surg,2023,44(2):182-188.DOI:10.3760/cma.j.cn421158-20211109-00546.
[5] Li ZY,Yang KL,Li XF,et al.Minimally invasive ureteral reimplantation or endoscopic management for primary obstructive megaureter:a narrative review of technical modifications and clinical outcomes[J].Transl Androl Urol,2022,11(12):1786-1797.DOI:10.21037/tau-22-448.
[6] Song SH,Kim IHA,Han JH,et al.Preoperative bladder bowel dysfunction is the most important predictive factor for postoperative urinary retention after robot-assisted laparoscopic ureteral reimplantation via an extravesical approach:a multi-center study[J].J Endourol,2021,35(2):226-233.DOI:10.1089/end.2020.0158.
[7] Herz D,Fuchs M,Todd A,et al.Robot-assisted laparoscopic extravesical ureteral reimplant:a critical look at surgical outcomes[J].J Pediatr Urol,2016,12(6):402.e1-402.e9.DOI:10.1016/j.jpurol.2016.05.042.
[8] Koyle MA,Butt H,Lorenzo A,et al.Prolonged urinary retention can and does occur after any type of ureteral reimplantantion[J].Pediatr Surg Int,2017,33(5):623-626.DOI:10.1007/s00383-017-4058-7.
[9] 中华医学会小儿外科学分会小儿泌尿外科学组.儿童原发性梗阻性巨输尿管症诊疗专家共识[J].中华小儿外科杂志,2022,43(8):679-684.DOI:10.3760/cma.j.cn421158-20220402-00233. Group of Pediatric Urology,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Diagnosing and Treating Primary Obstructed Megaureter in Children[J].Chin J Pediatr Surg,2022,43(8):679-684.DOI:10.3760/cma.j.cn421158-20220402-00233.
[10] 尿路感染诊断与治疗中国专家共识编写组.尿路感染诊断与治疗中国专家共识(2015版)-复杂性尿路感染[J].中华泌尿外科杂志,2015,36(4):241-244.DOI:10.3760/cma.j.issn.1000-6702.2015.04.001. Chinese Expert Consensus Compiling Group for Diagnosing and Treating Urinary Tract Infections:Chinese Expert Consensus on Diagnosing and Treating Urinary Tract Infections (2015 Edition):Complex Urinary Tract Infections[J].Chin J Urol,2015,36(4):241-244.DOI:10.3760/cma.j.issn.1000-6702.2015.04.001.
[11] 上海市医学会儿科学分会肾脏学组,上海市医学会小儿外科学分会,复旦大学附属儿科医院,等.中国儿童先天性肾积水早期管理专家共识[J].中国实用儿科杂志,2018,33(2):81-88.DOI:10.19538/j.ek2018020601. Group of Nephrology,Branches of Pediatrics and Pediatric Surgery,Shanghai Medical Association;Affiliated Children’s Hospital of Fudan University,et al.Expert Consensus on Early Management of Congenital Hydronephrosis in Chinese Children[J].Chin J Pract Pediatr,2018,33(2):81-88.DOI:10.19538/j.ek2018020601.
[12] Pokrzywa CJ,Papageorge CM,Kennedy GD.Preoperative urinary tract infection increases postoperative morbidity[J].J Surg Res,2016,205(1):213-220.DOI:10.1016/j.jss.2016.06.025.
[13] 李天,朱柏珍,李逊,等.上尿路结石患者输尿管软镜钬激光碎石术后感染状况研究[J].中华医院感染学杂志,2018,28(3):432-436.DOI:10.11816/cn.ni.2018-171335. Li T,Zhu BZ,Li X,et al.Postoperative infection status in upper urinary stones patients after Holmium laser lithotripsy by flexible ureteroscopy[J].Chin J Nosocomiol,2018,28(3):432-436.DOI:10.11816/cn.ni.2018-171335.
[14] [JP3] Kitano H,Shigemoto N,Koba Y,et al.Indwelling catheterization,renal stones,and hydronephrosis are risk factors for symptomatic Staphylococcus aureus-related urinary tract infection[J].World J Urol,2021,39(2):511-516.DOI:10.1007/s00345-020-03223-x.[JP]
[15] 万金平,林建贵,罗流涛,等.微通道和标准通道经皮肾镜碎石术中肾盂内压力、术后发热及手术效果比较的meta分析[J].中国当代医药,2022,29(11):20-23,28.DOI:10.3969/j.issn.1674-4721.2022.11.007. Wan JP,Lin JG,Luo LT,et al.Comparison of renal pelvic pressure,postoperative fever and effect of surgery between miniature and standard-tract percutaneous nephrolithotomy:a Meta-analysis[J].China Mod Med,2022,29(11):20-23,28.DOI:10.3969/j.issn.1674-4721.2022.11.007.
[16] Torino G,Roberti A,Brandigi E,et al.High-pressure balloon dilatation for the treatment of primary obstructive megaureter:is it the first line of treatment in children and infants?[J].Swiss Med Wkly,2021,151:w20513.DOI:10.4414/smw.2021.20513.
[17] Jude E,Deshpande A,Barker A,et al.Intravesical ureteric reimplantation for primary obstructed megaureter in infants under 1 year of age[J].J Pediatr Urol,2017,13(1):47.e1-47.e7.DOI:10.1016/j.jpurol.2016.09.009.
[18] Zhu WW,Zhou HX,Cao HL,et al.Modified technique for robot-assisted laparoscopic infantile ureteral reimplantation for obstructive megaureter[J].J Pediatr Surg,2022,57(12):1011-1017.DOI:10.1016/j.jpedsurg.2022.05.015.
[19] Kar M,Dubey A,Patel SS,et al.Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent and percutaneous nephrostomy tube[J].J Glob Infect Dis,2022,14(2):75-80.DOI:10.4103/jgid.jgid_276_21.
[20] Drinka PJ.Complications of chronic indwelling urinary catheters[J].J Am Med Dir Assoc,2006,7(6):388-392.DOI:10.1016/j.jamda.2006.01.020.
[21] Chuang L,Tambyah PA.Catheter-associated urinary tract infection[J].J Infect Chemother,2021,27(10):1400-1406.DOI:10.1016/j.jiac.2021.07.022.
[22] Garibaldi RA,Burke JP,Dickman ML,et al.Factors predisposing to bacteriuria during indwelling urethral catheterization[J].N Engl J Med,1974,291(5):215-219.DOI:10.1056/NEJM197408012910501.
[23] Flores-Mireles A,Hreha TN,Hunstad DA.Pathophysiology,treatment,and prevention of catheter-associated urinary tract infection[J].Top Spinal Cord Inj Rehabil,2019,25(3):228-240.DOI:10.1310/sci2503-228.
[24] Briaud P,Carroll RK.Extracellular vesicle biogenesis and functions in Gram-positive bacteria[J].Infect Immun,2020,88(12):e00433-20.DOI10.1128/IAI.00433-20.
[25] Kim JH,Lee J,Park J,et al.Gram-negative and Gram-positive bacterial extracellular vesicles[J].Semin Cell Dev Biol,2015,40:97-104.DOI:10.1016/j.semcdb.2015.02.006.
[26] TullusK,Shaikh N.Urinary tract infections in children[J].Lancet,2020,395(10237):1659-1668.DOI:10.1016/S0140-6736(20)30676-0.
[27] Wang J,Mou YR,Li AW.Comparison of open and pneumovesical cohen approach for treatment of primary vesicoureteral junction obstruction in children[J].J Laparoendosc Adv Surg Tech A,2020,30(3):328-333.DOI:10.1089/lap.2018.0791.
[28] Tae BS,Jeon BJ,Choi H,et al.Comparison of open and pneumovesical approaches for Politano-Leadbetter ureteric reimplantation:a single-center long-term follow-up study[J].J Pediatr Urol,2019,15(5):513.e1-513.e7.DOI:10.1016/j.jpurol.2019.05.033.
[29] Bustangi N,Kallas Chemaly A,Scalabre A,et al.Extravesical ureteral reimplantation following Lich-Gregoir technique for the correction of Vesico-Ureteral reflux retrospective comparative study open vs.laparoscopy[J].Front Pediatr,2018,6:388.DOI:10.3389/fped.2018.00388.
[30] Li W,Dong HZ,Chen P,et al.Surgical management of vesicoureteral junction obstruction in children:a comparative study between transvesicoscopic Cohen reimplantation and transumbilical laparoendoscopic single-site Lich-Gregoir techniques[J].J Endourol,2021,36(8):1043-1049.DOI:10.1089/end.2021.0309.
[31] Schwentner C,Oswald J,Lunacek A,et al.Lich-Gregoir reimplantation causes less discomfort than Politano-Leadbetter technique:results of a prospective,randomized,pain scale-oriented study in a pediatric population[J].Eur Urol,2006,49(2):388-395.DOI:10.1016/j.eururo.2005.11.015.
[32] Soh S,Kobori Y,Shin T,et al.Transvesicoscopic ureteral reimplantation:Politano-Leadbetter versus Cohen technique[J].Int J Urol,2015,22(4):394-399.DOI:10.1111/iju.12702.
[33] Zhu XJ,Wang J,Zhu HB,et al.Lich-Gregoir vesico-ureteral reimplantation for duplex kidney anomalies in the pediatric population:a retrospective cohort study between laparoscopic and open surgery[J].Transl Pediatr,2021,10(1):26-32.DOI:10.21037/tp-20-163.
相似文献/References:
[1]孙 邡
冯东川
朱孝宇.双J管在小儿小切口肾盂成形术中的应用[J].临床小儿外科杂志,2010,9(02):0.
[2]杨洋 张潍平 彭芸 温洋 杨吉刚.两种输尿管不全梗阻肾积水动物模型制作方法的比较[J].临床小儿外科杂志,2011,10(02):107.
Comparison of two different methods to establish animal model of hydronephrosis due to incomplete ureteral obstruction.[J].Journal of Clinical Pediatric Surgery,2011,10(04):107.
[3]杨艳芳.小儿先天性肾盂输尿管连接部梗阻126例[J].临床小儿外科杂志,2007,6(03):19.
[4]刘颖 毕允力. 气膀胱输尿管再植术治疗婴儿输尿管膀胱连接部梗阻临床分析[J].临床小儿外科杂志,2014,13(04):287.
[5]程时刚,陈海涛,耿红琼,等. Cajal细胞在先天性肾盂输尿管连接部梗阻中的分布及意义[J].临床小儿外科杂志,2015,14(06):506.
[6]王媛媛,宋翠萍,张海洋,等.先天性肾盂输尿管连接部梗阻手术后引流方式探讨[J].临床小儿外科杂志,2017,16(05):455.
[7]王文杰,宋宏程,谢向辉,等.肾盂输尿管连接部梗阻合并同侧原发性膀胱输尿管反流诊治分析[J].临床小儿外科杂志,2019,18(10):835.[doi:10.3969/j.issn.1671-6353.2019.10.007]
Wang Wenjie,Song Hongcheng,Xie Xianghui,et al.Experiences of diagnosing and treating ureteropelvic junction obstruction plus ipsilateral primary ureteral reflux[J].Journal of Clinical Pediatric Surgery,2019,18(04):835.[doi:10.3969/j.issn.1671-6353.2019.10.007]
[8]钟量,邹翔宇,孙杰.球囊扩张术治疗原发性梗阻型巨输尿管的可行性研究[J].临床小儿外科杂志,2023,22(02):139.[doi:10.3760/cma.j.cn101785-202202018-008]
Zhong Liang,Zou Xiangyu,Sun Jie.Feasibility analysis of balloon dilatation for primary obstructive megaureter[J].Journal of Clinical Pediatric Surgery,2023,22(04):139.[doi:10.3760/cma.j.cn101785-202202018-008]
备注/Memo
收稿日期:2023-04-13。
基金项目:国家自然科学基金委联合基金项目 (U1904208); 深圳市医学重点学科(2020—2024)(SZXK035)
通讯作者:李守林,Email:lishoulinsz@126.com