[1]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(04):334-339.[doi:10.12260/lcxewkzz.2021.04.007]
　Xu Hongye,Zhang Lingling,Du Guoqiang,et al.Analysis of risk factors of double J stent-related infection after laparoscopic pyeloplasty[J].Journal of Clinical Pediatric Surgery,2021,20(04):334-339.[doi:10.12260/lcxewkzz.2021.04.007]
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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

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第20卷 期数: 2021年04期 页码: 334-339 栏目: 专题·儿童肾积水分肾功能评估 出版日期: 2021-04-28
Title:
Analysis of risk factors of double J stent-related infection after laparoscopic pyeloplasty
作者:
徐宏业1;  张玲玲2;  杜国强1;  吴荣德1;  刘伟1
1. 山东大学附属省立医院小儿外科(山东省济南市, 250021);
2. 山东第一医科大学附属省立医院小儿外科(山东省济南市, 250021)
Author(s):
Xu Hongye1;  Zhang Lingling2;  Du Guoqiang1;  Wu Rongde1;  Liu Wei1
1. Department of Pediatric Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, China;
2. Department of Pediatric Surgery, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan 250021, China
关键词:
肾盂输尿管连接部梗阻; 腹腔镜检查; 泌尿外科手术; 手术后并发症; 引流术; 感染; 肾盂成形术
Keywords:
Ureteropelvic Junction Obstruction; Laparoscopy; Urologic Surgical Procedures; Postoperative Complications; Drainage; Infection; Pyeloplasty
分类号:
R726.9;R692.2;R693
DOI:
10.12260/lcxewkzz.2021.04.007
摘要:
目的 分析小儿肾盂输尿管连接部梗阻行腹腔镜肾盂成形术后，留置双J管期间发生泌尿系统感染的危险因素。方法 回顾性分析2015年11月至2020年10月由山东大学附属省立医院收治的单侧肾盂输尿管连接部梗阻、行腹腔镜肾盂成形术并留置双J管的患者121例，根据留置双J管期间是否发生泌尿系统感染，将患者分为感染组（n=14）和非感染组（n=107），分析泌尿系统感染的发生与患者的年龄、体重、性别、侧别、术前有无临床症状、肾盂前后径、肾皮质厚度、患肾分肾功能及双J管型号的关系。结果 留置双J管期间发生泌尿系统感染14例（11.57%）。本研究显示感染组与非感染组中性别、侧别、肾盂前后径、患肾分肾功能及双J管型号差异无统计学意义（P>0.05），而年龄（P=0.02）、体重（P=0.02）、术前有无临床症状（P=0.04）和肾皮质厚度（P=0.003）差异有统计学意义。进一步对年龄、体重、术前肾皮质厚度、术前有无临床症状进行二元Logistic回归分析，发现体重（OR=0.847，95%CI：0.721~0.994）和肾皮质厚度（OR=0.007，95%CI：0.000~0.491）是术后泌尿系统感染的独立危险因素。体重和术前肾皮质厚度预测术后是否发生泌尿系统感染的ROC曲线下区面积分别为0.70（95%CI：0.58~0.81，P<0.05）和0.74（95%CI：0.60~0.88，P<0.01），最佳截断值分别为13.75 kg和0.25 cm。结论 双J管相关性泌尿系统感染是腹腔镜肾盂成形术后较常见的并发症，体重<13.75 kg、术前肾皮质厚度<0.25 cm是术后泌尿系统感染的独立危险因素。
Abstract:
Objective To explore the risk factors of double J stent-related urinary tract infection after laparoscopic pyeloplasty(LP) in patients with ureteropelvic junction obstruction(UPJO).Methods A total of 121 UPJO children undergoing primary transperitoneal LP between November 2015 and October 2020 were retrospectively reviewed.Double J stents were inserted.According to the occurrence of urinary tract infection during indwelling double J stent, they were divided into infection and non-infection groups.Differences in age, body weight, gender, sideness, preoperative presentation, anteroposterior pelvic diameter, renal cortical thickness, split renal function and type of double J stent were compared.Results Double J stent related infection occurred in 14 cases(11.57%).Statistical analysis revealed no significant inter-group difference in gender, sideness, anteroposterior pelvic diameter, renal function or double J tube type.However, age(P=0.02), body weight(P=0.02), preoperative presentation(P=0.04) and renal cortex thickness(P=0.003) were significantly different between two groups.Body weight <13.75 kg and renal cortical thickness <0.25 cm were risk factors of postoperative double J stent-related infection.Conclusion Double J stent-related infection is a common complication after LP.Body weight and renal cortical thickness are risk factors for this complication.Children with low weight and renal cortical thickness should be closely watched for the occurrence of double J stent-related infection.

参考文献/References:

1 Turner RM 2nd,Fox JA,Tomaszewski JJ,et al.Laparoscopic pyeloplasty for ureteropelvic junction obstruction in infants[J].J Urol,2013,189(4):1503-1507.DOI:10.1016/j.juro.2012.10.067.
2 肖兴望,何大维.儿童肾盂输尿管连接处梗阻肾积水超声图像与非手术治疗预后相关性研究进展[J].中华实用儿科临床杂志,2019,34(11):873-876.DOI:10.3760/cma.j.issn.2095_428X.2019.11.018. Xiao XW,He DW.Research advances of correlations between ultrasonography and prognosis of non-surgical treatment to hydronephrosis caused by ureteropelvic junction obstruction in children[J].Chinese Journal of Applied Clinical Pediatrics,2019,34(11):873-876.DOI:10.3760/cma.j.issn.2095_428X.2019.11.018.
3 Chen JC,Zhang QL,Wang YJ,et al.Laparoscopic disconnected pyeloplasty to treat ureteropelvic junction obstruction(UPJO) in children[J].Med Sci Monit,2019,25:9131-9137.DOI:10.12659/MSM.918164.
4 Castillo OA,Cabrera W,Aleman E,et al.Laparoscopic pyeloplasty:technique and results in 80 consecutive patients[J].Actas Urol Esp,2014,38(2):103-108.DOI:10.1016/j.acuro.2013.04.010.
5 Rassweiler JJ,Teber D,Frede T.Complications of laparoscopic pyeloplasty[J].World J Urol,2008,26(6):539-547.DOI:10.1007/s00345-008-0266-z.
6 Soulié M,Salomon L,Patard JJ,et al.Extraperitoneal laparoscopic pyeloplasty:a multicenter study of 55 procedures[J].J Urol,2001,166(1):48-50.
7 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.
8 He Y,Song H,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-e11.DOI:10.1016/j.jpurol.2020.03.028.
9 刘鑫,刘舸,杨屹.儿童原发性膀胱输尿管反流手术干预相关因素分析[J].临床小儿外科杂志,2019,18(10):830-834.DOI:10.3969/j.issn.1671-6353.2019.10.006. Liu X,Liu G,Yang Y.Predicative factors and optimal timing for surgical repair in children with primary vesicoureteral reflux[J].J Clin Ped Sur,2019,18(10):830-834.DOI:10.3969/j.issn.1671-6353.2019.10.006.
10 Imam MS,Al Farooq MA,Sarwar MKA,et al.A comparison between short-and long-term D-J stent in Anderson-Hynes pyeloplasty for pelvi-ureteric junction obstruction[J].Pediatr Surg Int,2020,36(11):1363-1370.DOI:10.1007/s00383-020-04734-9.
11 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 catheterization placement and time after pediatric ureteropelvic junction angioplasty[J].Chinese Journal of Nosocomiology,2018,28(15):2381-2384,2393.DOI:10.11816/cn.ni.2018-172983.
12 石从整,周琼,蒋立新,等.双J管相关泌尿系感染临床特点分析[J].武汉大学学报(医学版),2020,41(3):448-452.DOI:10.14188/j.1671-8852.2019.0382. Shi CZ,Zhou Q,Jiang LX,et al.Clinical characteristics and mechanism of double J tube related infection[J].Medical Journal of Wuhan University,2020,41(3):448-452.DOI:10.14188/j.1671-8852.2019.0382.
13 Fedelini P,Verze P,Meccariello C,et al.Intraoperative and postoperative complications of laparoscopic pyeloplasty:a single surgical team experience with 236 cases[J].J Endourol,2013,27(10):1224-1229.DOI:10.1089/end.2013.0301.
14 Badawy H,Saad A,Fahmy A,et al.Prospective evaluation of retroperitoneal laparoscopic pyeloplasty in children in the first 2 years of life:Is age a risk factor for conversion?[J].J Pediatr Urol,2017,13(5):511.e1-e4.DOI:10.1016/j.jpurol.2017.03.025.
15 Ludwikowski BM,Botl?nder M,González R.The BULT Method for Pediatric Minilaparoscopic Pyeloplasty in Infants:Technique and Results[J].Front Pediatr,2016,4:54.DOI:10.3389/fped.2016.00054.
16 Zamfir Snykers C,De Plaen E,Vermersch S,et al.Is laparoscopic pyeloplasty for ureteropelvic junction obstruction in infants under 1 year of age a good option?[J].Front Pediatr,2019,7:352.DOI:10.3389/fped.2019.00352.
17 张一帆,郝春生,任玉乾.腹腔镜下Anderson-Hynes肾盂输尿管成形术治疗6个月以下婴儿肾盂输尿管连接部梗阻[J].中国微创外科杂志,2019,19(7):587-591.DOI:10.3969/j.issn.1009-6604.2019.07.004. Zhang YF,Hao CS,Ren YQ.Laparoscopic Anderson-Hynes pyeloureteroplasty for ureteropelvic junction obstruction in infants aged under 6 months[J].Chinese Journal of Minimally Invasive Surgery,2019,19(7):587-591.DOI:10.3969/j.issn.1009-6604.2019.07.004.
18 柴红超,周云,王静茹,等.肾积水患者并发症危险因素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].Clinical Journal of Medical Officers,2019,47(11):1268-1269,1275.DOI:10.16680/j.1671-3826.2019.11.40.

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备注/Memo

收稿日期:2020-12-29。
通讯作者:刘伟,Email:lemontree1119@126.com

更新日期/Last Update: 1900-01-01