微创医学

目的探讨输尿管软镜碎石术治疗输尿管结石的临床疗效，并分析术后泌尿系统感染的影响因素。方法回顾性分析140例输尿管结石患者的临床资料，所有患者均行输尿管软镜碎石术。手术前后，比较患者的临床指标［疼痛视觉模拟评分法（VAS）评分、氧化应激指标（血清丙二醛、促肾上腺皮质激素及皮质醇水平）、结石清除率］，根据术后是否发生感染，将所有患者分为感染组与未感染组，应用多因素Logistic回归模型分析患者术后发生泌尿系统感染的危险因素。结果与术前比较，术后患者疼痛VAS评分降低，血清丙二醛、皮质醇、促肾上腺皮质激素水平升高（P<0.05）。在140例患者中，术后结石清除129例，结石总清除率为92.14%，术后发生泌尿系统感染32例，感染率为22.86%。感染组和未感染组结石直径、手术时长、双J管留置时间、肾积水程度，术前白细胞计数、中性粒细胞计数，术前血清C反应蛋白、胱抑素C水平比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，术前白细胞计数升高、血清C反应蛋白水平升高，双J管留置时间>7 d、结石直径>3 cm、手术时间>60 min、重度肾积水是影响患者术后发生泌尿系统感染的危险因素（P<0.05）。结论输尿管软镜碎石术治疗输尿管结石创伤小、结石清除效果确切，可有效缓解患者疼痛；术前白细胞计数升高、血清C反应蛋白高水平，双J管留置时间>7 d、结石直径>3 cm、手术时间>60 min、重度肾积水是影响患者发生术后泌尿系统感染的危险因素。

Objective To investigate the clinical efficacy of flexible ureteroscopic lithotripsy for ureteral calculi and analyze the influencing factors of postoperative urinary tract infection. Methods The clinical data of 140 patients with ureteral calculi who underwent flexible ureteroscopic lithotripsy were retrospectively analyzed. Preoperative and postoperative clinical indicators including visual analogue scale (VAS) score for pain, oxidative stress indicators (serum malondialdehyde, adrenocorticotropic hormone and cortisol levels), and stone clearance rate were compared. All patients were divided into infection group and non-infection group according to the presence or absence of postoperative infection. Multivariate Logistic regression model was used to analyze the risk factors for postoperative urinary tract infection in patients. Results Compared with patients' preoperative levels, postoperative pain VAS scores decreased, while the levels of serum malondialdehyde, cortisol, and adrenocorticotropic hormone increased (P<0.05). Among the 140 patients, 129 achieved postoperative stone clearance, with an overall stone clearance rate of 92.14%. Postoperative urinary tract infection occurred in 32 patients, corresponding to an infection rate of 22.86%. There were statistically significant differences between the infection group and non-infection group in stone diameter, operative duration, indwelling time of double-J stent, degree of hydronephrosis, preoperative white blood cell count and neutrophil count, preoperative serum C-reactive protein and cystatin C levels (P<0.05). Multivariate Logistic regression analysis showed that elevated preoperative white blood cell count, evaluated preoperative serum C-reactive protein level, double-J stent indwelling time >7 days, stone diameter >3 cm, operative duration >60 min and severe hydronephrosis were risk factors for postoperative urinary tract infection (P<0.05). Conclusion Flexible ureteroscopic lithotripsy achieves effective pain relief with minimal invasiveness and satisfactory stone clearance in patients with ureteral calculi. Elevated preoperative white blood cell count and high serum C-reactive protein level, double-J stent indwelling duration >7 days, stone diameter >3 cm, operative duration >60 min and severe hydronephrosis are risk factors for postoperative urinary tract infection.