重复肾伴重复输尿管末端囊肿患儿开窗术后感染危险因素分析

doi:10.3877/cma.j.issn.1674-3253.2023.02.010

目的

探讨重复肾伴重复输尿管末端囊肿患儿开窗术后发生感染的相关因素，并探讨相应的预防措施。

方法

回顾性分析重庆医科大学附属儿童医院2010至2020年间收治的重复肾伴重复输尿管末端囊肿并行输尿管末端囊肿开窗术的患儿共37例，记录患儿个人信息、临床表现、术前诊断、辅助检查、手术情况、术后并发症和随访时间等。

结果

重复肾伴重复输尿管末端囊肿行开窗术患者共37例，其中12例（32.4%）因术后反复感染再次于门诊或住院行内科抗感染治疗（9例，24.3%）或二次手术治疗（3例，8.1%），术后并发尿路感染与性别、年龄、囊肿大小、扩张输尿管直径、手术时间等方面无明显相关（P>0.05），而术前存在泌尿系感染史是患儿开窗术后泌尿系感染的危险因素（P<0.05）。

结论

重复肾伴重复输尿管末端囊肿患儿行输尿管末端囊肿开窗术后有可能出现术后感染，故应谨慎选择病例，严格掌握手术适应证，同时注意术中开窗方式的选择，并且加强围术期治疗过程中的抗感染治疗，优化护理方案，减少感染的发生。

关键词: 重复肾输尿管, 输尿管囊肿, 开窗术, 泌尿系感染, 危险因素

Objective

To investigate the risk factors of urinary tract infection of transurethral cystoscopic incision and drainage for duplex kidney, ureteral duplication accompanied ureter in children, and to explore the corresponding preventive measures.

Methods

A total of 37 children who underwent fenestration of ureterocele were admitted in Children's Hospital of Chongqing Medical University from 2010 to 2020 with duplex kidney and ureter combined with ureterocele. The information, clinical manifestations, preoperative diagnosis, auxiliary examination and surgery, postoperative complications and follow-up time of which were enrolled in a retrospective analysis.

Results

A total of 37 patients underwent transurethral cystoscopic incision and drainage, 12 cases (32.4%) received anti-infective treatment in outpatient or inpatient department (9 cases, 24.3%) or secondary surgical treatment (3 cases, 8.1%) due to postoperative recurrent infection. Postoperative urinary infection was not related to gender, age, cyst size, dilated ureter diameter, operation time (P>0.05). The presence of a history of urinary tract infection before surgery was a risk factor for urinary infection after fenestration (P<0.05).

Conclusions

Duplex kidney and ureter combined with ureterocele in children who underwent fenestration of ureterocele have chance to get postoperative infection, therefore, we should be careful to choose cases, to grasp the surgical indications strictly, at the same time pay attention to the choice of the ways of fenestration, strengthen the perioperative treatment of anti-infection treatment, and optimize the nursing plan to reduce infection.

Key words: Duplex kidney and ureter, Ureterocele, Fenestration, Urinary tract infection, Risk factors

表1 囊肿开窗术后并发泌尿系感染的单因素分析

因素	分类	例数	术后感染(例)	术后未感染(例)	P值
年龄	< 2岁	23	9	14	>0.05
年龄	≥2岁	14	3	11
性别	男性	8	4	4	>0.05
性别	女性	29	8	21
囊肿大小	< 2.5 cm	15	5	10	>0.05
囊肿大小	≥2.5 cm	22	7	15	>0.05
扩张直径	< 1.0 cm	13	3	10
扩张直径	≥1.0 cm	24	9	15
术前情况	感染	21	10	11	<0.05
术前情况	未感染	16	2	14
手术时间	< 30 min	19	7	12	>0.05
手术时间	≥30 min	18	5	13

表1 囊肿开窗术后并发泌尿系感染的单因素分析

因素	分类	例数	术后感染(例)	术后未感染(例)	P值
年龄	< 2岁	23	9	14	>0.05
年龄	≥2岁	14	3	11
性别	男性	8	4	4	>0.05
性别	女性	29	8	21
囊肿大小	< 2.5 cm	15	5	10	>0.05
囊肿大小	≥2.5 cm	22	7	15	>0.05
扩张直径	< 1.0 cm	13	3	10
扩张直径	≥1.0 cm	24	9	15
术前情况	感染	21	10	11	<0.05
术前情况	未感染	16	2	14
手术时间	< 30 min	19	7	12	>0.05
手术时间	≥30 min	18	5	13

表2 囊肿开窗术后并发泌尿系感染的多因素Logistic回归分析

相关因素	B	S.E.	Wald	P值	95%CI
术前感染	-2.124	1.008	4.441	0.035	0.017~0.862

表2 囊肿开窗术后并发泌尿系感染的多因素Logistic回归分析

相关因素	B	S.E.	Wald	P值	95%CI
术前感染	-2.124	1.008	4.441	0.035	0.017~0.862

[1]	Varlatzidou A, Zarokosta M, Nikou E, et al. Complete unilateral ureteral duplication encountered during intersphinctericresection for low rectal cancer[J]. J Surg Case Rep, 2018, 2018(10): 1-3.
[2]	Park JS, Lee YS, Lee CN, et al. Transurethral incision as initial option in treatment guidelines for ectopic ureteroceles associated with duplex systems[J]. World J Urol, 2019, 37(10): 2237-2244.
[3]	Wein AJ, Kavoussi LR, Partin AW, et al. Campbell Walsh Urology(Eleventh Edition)[M]. Philadelphia: Elsevier Inc, 2016: 3075.
[4]	陈金卫, 王红英, 张蕊, 等. 超声对小儿异位肾及其伴发畸形的临床诊断价值[J]. 影像研究与医学应用, 2020, 4(16): 185-188.
[5]	孙洪赞, 张立欧, 张思雨. IVP联合IVP后泌尿系三维重建CT在诊断小儿重复肾畸形中的价值[J]. 临床泌尿外科杂志, 2017, 32(11): 836-839.
[6]	Lee YS, Im YJ, Shin SH. Complications after common sheath reimplantation in pediatric patients with complicated duplex system[J]. Urology, 2015, 85(2): 457-462.
[7]	覃道锐, 唐耘熳, 毛宇, 等. 腹腔镜下半肾及输尿管切除治疗小儿重复肾[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(1): 39-42.
[8]	Michaud JE, Akhavan A. Upper poleheminephrectomy versus lower pole ureteroureterostomy for ectopic upper pole ureters[J]. Curr Urol Rep, 2017, 18(3): 21.
[9]	Sander JC, Bilgutay AN, Stanasel I, et al.Outcomes of endoscopic incision for the treatment of ureterocele in children at a single institution[J]. J Pediatr Urol, 2015, 194(4): 1171-1172.
[10]	Caione P, Gerocarni Nappo S, Collura G, et al. Minimally invasive laser treatment of ureterocele[J]. Front Pediatr, 2019, 7: 106
[11]	Adorisio O, Elia A, Landi L, et al. Effectiveness of primary endoscopic incision intreatment of ectopic ureterocele associated with duplex system[J]. Urology, 2011, 77(1): 191-194．
[12]	Cooper CS, Passerini-Glazel G, HutchesonJC, et al．Long-term followup of endoscopic incision of ureteroceles: intravesical versus extravesical[J]. J Urol, 2000, 164(3): 1097-1100.
[13]	Aikins K, Taghavi K, Grinlinton M, et al. Cystoscopic transurethral incision in simple and duplex ureteroceles-is it the definitive procedure?[J]. J Pediatr Urol, 2019, 15(5): 560.
[14]	Nguyen DH, Brown CT. Puncture of prolapsed ureterocele at bedside without anesthesia or sedation[J]. J Pediatr Urol, 2020, 16(3): 390-391.
[15]	涂忠, 钱卫红, 饶作祥, 等. 输尿管膨出的微创手术治疗[J]. 临床外科杂志, 2008, 16(4): 262-263.

[1]	明昊, 肖迎聪, 巨艳, 宋宏萍. 乳腺癌风险预测模型的研究现状[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(05): 287-291.
[2]	庄燕, 戴林峰, 张海东, 陈秋华, 聂清芳. 脓毒症患者早期生存影响因素及Cox 风险预测模型构建[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 372-378.
[3]	黄鸿初, 黄美容, 温丽红. 血液系统恶性肿瘤患者化疗后粒细胞缺乏感染的危险因素和风险预测模型[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 285-292.
[4]	罗文斌, 韩玮. 胰腺癌患者首次化疗后中重度骨髓抑制的相关危险因素分析及预测模型构建[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 357-362.
[5]	贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[6]	林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.
[7]	杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[8]	周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[9]	张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[10]	司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[11]	颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[12]	刘文静, 陈升鑫, 陈德鑫, 方开萱, 梁雅文, 李明阳, 翟亚奇. 酒精性慢性胰腺炎急性发作相关因素分析：一项多中心回顾性研究[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(04): 248-252.
[13]	李文哲, 王毅, 崔建, 郑启航, 王靖彦, 于湘友. 新疆维吾尔自治区重症患者急性肾功能异常的危险因素分析[J/OL]. 中华卫生应急电子杂志, 2024, 10(05): 269-276.
[14]	刘志超, 胡风云, 温春丽. 山西省脑卒中危险因素与地域的相关性分析[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 424-433.
[15]	曹亚丽, 高雨萌, 张英谦, 李博, 杜军保, 金红芳. 儿童坐位不耐受的临床进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 510-515.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Risk factors of infection after fenestration for duplex kidney and ureter combined with ureterocele in children

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Risk factors of infection after fenestration for duplex kidney and ureter combined with ureterocele in children