Fu Xiaobao,Xu Nana,Li Xiaoran,et al.Analysis of influencing factors of fever after laparoscopic pyeloplasty in children[J].Journal of Clinical Pediatric Surgery,2026,(05):457-461.[doi:10.3760/cma.j.cn101785-202405061]
儿童腹腔镜肾盂成形术后发热的影响因素分析
- Title:
- Analysis of influencing factors of fever after laparoscopic pyeloplasty in children
- Keywords:
- Ureter; Renal Pelvis; Laparoscope; Fever; Root Cause Analysis; Child
- 摘要:
- 目的 探讨儿童先天性肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)行腹腔镜肾盂成形术(laparoscopic pyeloplasty,LP)后住院期间发热的特点及影响因素,为LP后发热的预防与干预提供参考。方法 回顾性分析2018年6月至2023年8月兰州大学第二医院泌尿外科同一手术团队收治的143例先天性UPJO并行首次单侧LP(术中放置输尿管支架管)患儿的临床资料。统计患儿术后发热持续时间(duration of postoperative fever,DPF)、术后最高体温(highest postoperative body temperature,HPBT)及术后高热(postoperative high fever,PHF,体温≥39℃)发生情况,分析性别、年龄、手术侧别、手术时间、术中出血量、体重、术后漏尿、术前尿常规异常(abnormity of urine routine,AUR)、术前肾盂前后径(anteroposterior diameter,APD)、术中置入支架管型号等变量与DPF、HPBT及PHF的相关性。结果 DPF、HPBT与手术时间、术中出血量、体重、术前APD无相关性,在性别、手术侧别中的差异无统计学意义(P>0.05)。年龄与DPF呈负相关(r=-0.307,P<0.01);DPF与HPBT呈正相关(r=0.717,P<0.01)。DPF在支架管型号(P=0.003)、术前AUR(P<0.01)中的差异有统计学意义,在术后漏尿(P=0.112)中的差异无统计学意义;HPBT在支架管型号(P=0.01)、术后漏尿(P=0.04)、术前AUR(P<0.01)中的差异有统计学意义,但术后漏尿对HPBT的影响无明显临床意义。支架管型号两两比较显示:DPF方面,F3型号与F4、F4.7型号差异有统计学意义(P=0.020、P=0.018),F4与F4.7型号差异无统计学意义(P=1.000);HPBT方面,F3与F4.7型号差异有统计学意义(P=0.043),F4与F3、F4.7型号差异无统计学意义(P=0.052、P=1.000)。术前AUR是PHF的独立危险因素(OR=3.750,95%CI:1.439~9.774,P=0.007),在其他变量中的差异无统计学意义。结论 发热是儿童LP术后常见并发症。术前AUR对DPF、HPBT有显著影响,且是PHF的独立危险因素。临床需加强术前AUR患儿术后体温监测,警惕症状性尿路感染发生,可考虑对无症状性AUR患儿术前延长抗菌素疗程至尿常规正常,以利于术后发热的控制。
- Abstract:
- Objective Toexplore the characteristics and related influencing factors of fever during hospitalization after laparoscopic pyeloplasty (LP) for congenital ureteropelvic junction obstruction (UPJO) in children to provide references for the prevention and intervention of postoperative fever in clinical practices.Methods A retrospective analysis was performed for the relevant clinical data of 143 children with congenital UPJO undergoing primary unilateral LP (with intraoperative ureteral stenting) by the same surgical team at Department of Urology,Second Hospital of Lanzhou University from June 2018 to August 2023.Duration of postoperative fever (DPF),highest postoperative body temperature (HPBT) and postoperative high fever (PHF,body temperature ≥39℃) were recorded.The correlations between such variables as gender,age,surgical sideness,operative duration,intraoperative bleeding volume,weight,postoperative urinary leakage,preoperative abnormity of urine routine (AUR),preoperative anteroposterior diameter (APD) of renal pelvis and intraoperative stent type with DPF/HPBT/PHF were examined.Results No correlation existed between DPF,HPBT,operative duration,intraoperative bleeding volume,weight or preoperative APD.And there was no significant difference in gender or surgical sideness (P>0.05).Age was correlated negatively with DPF (r=-0.307,P<0.01); DPF was significantly correlated positively with HPBT (r=0.717,P<0.01).DPF showed significant differences in stent type (P=0.003) and preoperative AUR (P<0.01).However,no significant difference existed in postoperative urinary leakage (P=0.112); HPBT showed significant differences in stent type (P=0.01),postoperative urinary leakage (P=0.04) and preoperative AUR (P<0.01).However,impact of postoperative urinary leakage on HPBT had no obvious clinical significance.Pairwise comparison of stent types indicated that,in terms of DPF,there were significant differences between F3 and F4,F3 and F4.7 (P=0.020,P=0.018) while no significant difference existed between F4 and F4.7 (P=1.000); in terms of HPBT,there was a significant difference between F3 and F4.7 (P=0.043).However,there was no significant differences between F4 and F3,F4 and F4.7 (P=0.052,P=1.000).Preoperative AUR was an independent risk factor for PHF (OR=3.750,95%CI:1.439-9.774,P=0.007).There were no significant differences in other variables.Conclusion Fever is a common complication after LP in children.With a significant impact on DPF and HPBT,preoperative AUR is an independent risk factor for PHF.Clinically,it is imperative to strengthen the postoperative temperature monitoring of children with preoperative AUR and stay on a high alert for the occurrence of symptomatic urinary tract infection.For children with asymptomatic AUR,prolonging preoperative antibiotic course until a normalization of urine routine may facilitate the control of postoperative fever.
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备注/Memo
收稿日期:2024-5-26。
通讯作者:杨宁强,Email:yangnq0488@163.com