摘要
目的探讨输尿管结石患者术前CT继发影像特征对输尿管镜下钬激光碎石患者术后发热性尿路感染(UTI)的预测价值。方法收集因输尿管结石行输尿管镜碎石术(URS)治疗的501例患者进行回顾性分析。根据URS术后出现发热性UTI分为非发热组(A组)与发热组(B组),其中A组432例,B组69例,统计比较两组间的临床因素、结石因素及结石梗阻的继发CT特征改变。采用多变量logistic回归模型分析URS后发热性UTI的预测因素。结果 501例患者中69例出现发热性UTI。在单因素分析中,体质指数(t=3.745,P<0.001)、糖尿病(χ^(2)=12.969,P<0.001)、慢性肾功能不全(χ^(2)=18.427,P<0.001)、结石位置(χ^(2)=6.491,P=0.039)、结石大小(t=10.624,P<0.001)、肾积水(χ^(2)=5.314,P=0.021)、输尿管积水(χ^(2)=11.108,P=0.001)、肾积水CT值(t=12.401,P<0.001)、肾周脂肪链(χ^(2)=43.874,P<0.001)、输尿管周围脂肪链(χ^(2)=21.270,P<0.001)、组织边缘征(χ^(2)=21.750,P<0.001)、手术时间(t=3.728,P<0.001)差异有统计学意义,而年龄、性别、高血压、既往存在急性肾盂肾炎、既往存在结石手术病史、结石CT值、结石边侧、结石数量、结石清除率差异无统计学意义(P>0.05)。在多因素logistic回归分析中,糖尿病(Wald值7.917,P=0.005)、慢性肾功能不全(Wald值12.570,P<0.001)、结石大小(Wald值11.570,P=0.001)、肾周脂肪链(Wald值23.477,P<0.001)、组织边缘征(Wald值19.644,P<0.001)、肾积水CT值(Wald值5.450,P=0.02)、手术时间(Wald值8.812,P=0.003)是URS术后发热性UTI的独立预测因素。结论继发征象包括术前CT上的肾周脂肪链、组织边缘征、肾积水CT值、结石大小、慢性肾功能不全、糖尿病、手术时间是URS后发热性UTI的独立预测因素。
Objective To evaluate the predictive value of preoperative CT features secondary to ureteral stone obstruction in febrile urinary tract infection after ureteroscopic lithotripsy. Methods In total, 501 patients who underwent URS for ureteral stones were retrospectively included in this study. According to febrile urinary tract infection after URS, they were divided into non-febrile group(Group A, n=432) and febrile group(Group B, n=69). The clinical factors, stone factors and the changes in the secondary CT characteristics of stone obstruction between the two groups were statistically compared. Multivariate logistic regression model was used to analyze the predictors of febrile UTI after URS. Results Febrile UTI occurred in 69 patients(69/501). In univariate analysis, there were significant differences in BMI(t=3.745, P<0.001), diabetes mellitus(χ^(2)=12.969, P<0.001), chronic renal insufficiency(χ^(2)=18.427, P<0.001), stone location(χ^(2)=6.491, P=0.039), stone size(t=10.624, P<0.001), hydronephrosis(χ^(2)=5.314, P=0.021), hydroureterosis(χ^(2)=11.108, P=0.001), CT value of hydronephrosis(t=12.401, P<0.001), perinephric fat stranding(χ^(2)=43.874, P<0.001), periureteral fat stranding(χ^(2)=21.270, P<0.001), tissue rim sign(χ^(2)=21.750, P<0.001), and operative time(t=3.728, P<0.001) between the 2 groups;while there was no statistically significant difference in age, gender, hypertension, previous acute pyelonephritis, previous history of calculi operation, calculi CT value, stone side by side, stone number or stone clearance rate between them(P>0.005). In multivariate logistic regression analysis, diabetes mellitus(Wald value 7.917, P=0.005), chronic renal insufficiency(Wald value 12.570, P<0.001), stone size(Wald value 11.570, P=0.001), perirenal adipose chain(Wald value 23.477, P<0.001), tissue marginal sign(Wald value 19.644, P<0.001), CT value of hydronephrosis(Wald value 5.450, P=0.02), and operation time(Wald value 8.812, P=0.003) were independent predictors of febrile UTI after URS. Conclusion Thi
作者
卢扬柏
张泳欣
黄红星
黄亚强
曹彬
冷区
袁润强
黎卫
LU Yang-bai;ZHANG Yong-xin;HUANG Hong-xing;HUANG Ya-qiang;CAO Bin;LENG Qu;YUAN Run-qiang;LI Wei(Department of Urology,Zhongshan City People's Hospital Affiliated to Sun Yat-sen University,Zhongshan 528403,Guangdong,China;不详)
出处
《广东医学》
CAS
2021年第8期955-961,共7页
Guangdong Medical Journal
基金
中山市医学科研项目(2019J042)
中山市科技计划项目(2019B1063,2019B1073)。
