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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 149 -153. doi: 10.3877/cma.j.issn.1674-3253.2023.02.010

临床研究

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
倪园松1, 华燚1,†(), 石艳1, 杨猛1, 黄一天1, 刘星1, 刘俊宏1, 张德迎1, 刘丰1, 吴盛德1   
  1. 1. 400010　重庆医科大学附属儿童医院泌尿外科
  • 收稿日期:2022-02-21 出版日期:2023-04-01
  • 通信作者: 华燚

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

Yuansong Ni1, Yi Hua1,†(), Yan Shi1, Meng Yang1, Yitian Huang1, Xing Liu1, Junhong Liu1, Deying Zhang1, Feng Liu1, Shengde Wu1   

  1. 1. Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400010, China
  • Received:2022-02-21 Published:2023-04-01
  • Corresponding author: Yi Hua
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倪园松, 华燚, 石艳, 杨猛, 黄一天, 刘星, 刘俊宏, 张德迎, 刘丰, 吴盛德. 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[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(02): 149-153.

Yuansong Ni, Yi Hua, Yan Shi, Meng Yang, Yitian Huang, Xing Liu, Junhong Liu, Deying Zhang, Feng Liu, Shengde Wu. Risk factors of infection after fenestration for duplex kidney and ureter combined with ureterocele in children[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(02): 149-153.

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
≥2岁 14 3 11  
性别 男性 8 4 4 >0.05
女性 29 8 21  
囊肿大小 < 2.5 cm 15 5 10 >0.05
≥2.5 cm 22 7 15 >0.05
扩张直径 < 1.0 cm 13 3 10
≥1.0 cm 24 9 15
术前情况 感染 21 10 11 <0.05
未感染 16 2 14  
手术时间 < 30 min 19 7 12 >0.05
≥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
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