CAJ | 학술논문

目的：对输尿管软镜钬激光碎石术治疗肾结石后发生全身炎症反应综合征（SIRS）的高危因素进行分析。方法回顾性分析自2011年10月至2013年2月因肾结石接受输尿管软镜治疗患者的临床资料。根据术后是否发生SIRS，将患者分为两组，通过单因素分析和多因素回归分析探索术后SIRS发生的高危因素。结果在561例患者（男性381例，女性180例）中，5．2％（29／561）术后出现SIRS表现。单因素分析显示，双侧手术（P＝0．032），慢性肾功能不全（P＝0．041），肾脏解剖畸形（P＝0．035），近期因结石发热病史（P ＜0．001），患侧泌尿系结石手术治疗史（P ＝0．010），术前中段尿培养阳性（P ＜0．001），术中感染迹象（P＜0．001），磷酸铵镁结石（P＜0．001）在两组患者中存在显著差异。而患者年龄、性别、BMI、手术时间、结石大小、糖尿病史、孤立肾患者、术前肌酐水平、术前放置双J管、术中放置输尿管软镜鞘等因素均与术后SIRS的发生无显著相关性（P＞0．05）。多因素回顾分析进一步证实，术前未放置双J管（P＝0．021）、近期因结石发热病史（P＜0．001）以及术中感染迹象（P＜0．001）是输尿管软镜碎石术后SIRS发生的高危因素。结论术前未放置双J管、近期因结石发热病史以及术中感染迹象增加了输尿管软镜碎石术后SIRS发生的风险，应注意询问相关病史，完善术前检查，预防尿脓毒血症的发生。
목적：대수뇨관연경화격광쇄석술치료신결석후발생전신염증반응종합정（SIRS）적고위인소진행분석。방법회고성분석자2011년10월지2013년2월인신결석접수수뇨관연경치료환자적림상자료。근거술후시부발생SIRS，장환자분위량조，통과단인소분석화다인소회귀분석탐색술후SIRS발생적고위인소。결과재561례환자（남성381례，녀성180례）중，5．2％（29／561）술후출현SIRS표현。단인소분석현시，쌍측수술（P＝0．032），만성신공능불전（P＝0．041），신장해부기형（P＝0．035），근기인결석발열병사（P ＜0．001），환측비뇨계결석수술치료사（P ＝0．010），술전중단뇨배양양성（P ＜0．001），술중감염적상（P＜0．001），린산안미결석（P＜0．001）재량조환자중존재현저차이。이환자년령、성별、BMI、수술시간、결석대소、당뇨병사、고립신환자、술전기항수평、술전방치쌍J관、술중방치수뇨관연경초등인소균여술후SIRS적발생무현저상관성（P＞0．05）。다인소회고분석진일보증실，술전미방치쌍J관（P＝0．021）、근기인결석발열병사（P＜0．001）이급술중감염적상（P＜0．001）시수뇨관연경쇄석술후SIRS발생적고위인소。결론술전미방치쌍J관、근기인결석발열병사이급술중감염적상증가료수뇨관연경쇄석술후SIRS발생적풍험，응주의순문상관병사，완선술전검사，예방뇨농독혈증적발생。
Objective Analyze the risk factors that affect the development of postoperative systemic inflam-matory response syndrome (SIRS)following flexible ureteroscopy (f-URS)in the treatment of renal stones. Patients and methods We retrospectively analyzed the data of f-URS in the treatment of renal stones between October 2011 and February 2013 . The patients were divided into two groups as patients developing SIRS and not developing SIRS. Univariate and multivariate statistical analyses were performed to determine factors affecting the development of SIRS. Results The study included 561 patients (381 male and 180 female),among whom 5. 2%(29/561)developed SIRS. In the univariate analysis,there was significant difference between the two groups in bilateral operation (P = 0 . 032 ),history of chronic renal insufficiency (P = 0 . 041 ),kidney anatomic de-formity (P = 0 . 035 ),a recent history of stone related fever (P < 0 . 001 ),operation history of the same side urinary stones (P = 0 . 010 ),preoperative positive urine culture (P < 0 . 001 ),endoscopic signs of infection (P < 0. 001),the stone of magnesium ammonium phosphate (P < 0. 001). While age,gender,BMI,opera-tive time,stone burden,history of diabetes,proportion of the isolated kidney,preoperative creatinine level, proportion of preoperative double-J placement,proportion of ureteral access sheath placement were not related to the development of SIRS. Multivariate analysis further confirmed that without preoperative placement of double-J (P = 0 . 021 ),a recent history of stone related fever (P < 0 . 001 ),and endoscopic signs of infection (P< 0. 001)were the high risks of SIRS following f-URS in the treatment of renal stones. Conclusions Without preoperative placement of double-J,a recent history of stone related fever,and endoscopic signs of infection are significant predictors of SIRS following f-URS in the treatment of renal stones. Attention should be paid to ask the related history and improve preoperative examinations,preventing the development of urosepsis.