经皮肾镜碎石术术中肾盂内压对预测术后感染的影响

目的 探讨经皮肾镜碎石术（PCNL）术中肾盂内压对术后感染的影响。方法 回顾性分析2017年12月~2018年2月我院79例行PCNL患者的临床资料，根据PCNL术后感染情况分为术后感染组（14例）和术后正常组（65例），比较两组临床特点及术中肾盂内压力变化对术后感染的影响。结果 两组年龄、性别、高血压病史、糖尿病病史、体重指数、结石大小及术中失血量比较，差异无统计学意义（P＞0.05）；两组手术时间、IPP比较，差异有统计学意义（P＜0.05）。多因素Logistic分析结果显示，手术时间和IPP是PCNL术后感染的危险因素。ROC曲线分析结果显示，IPP最佳截断值为37.5 mmHg，敏感性为56.92%，特异性为96.89%，曲线下面积为0.865，95%CI:0.704~0.946；手术时间最佳截断值为59.92 min，敏感性为52.31%，特异性为92.86%，曲线下面积为0.821，95%CI:0.738~0.984。结论 术中肾盂内压及手术时间是PCNL术后感染的独立危险因素，因此需监控IPP，避免因IPP过高引起术后感染。

Effect of Intrapelvic Pressure during Percutaneous Nephrolithotomy on Predicting Postoperative Infection

Objective To investigate the effect of intrapelvic pressure on postoperative infection during percutaneous nephrolithotomy (PCNL). Methods The clinical data of 79 patients with PCNL in our hospital from December 2017 to February 2018 were retrospectively analyzed. They were divided into postoperative infection group (14 cases) and normal postoperative group (65 cases) according to PCNL postoperative infection status. The clinical characteristics of the two groups and the effects of intra-pelvic pressure changes on postoperative infections were compared. Results There were no significant differences in age, gender, history of hypertension, history of diabetes, body mass index, stone size, and blood loss during the two groups (P>0.05). There was statistically significant difference in surgical time and IPP between the two groups (P<0.05). Multivariate Logistic analysis showed that operation time and IPP were risk factors for PCNL infection. The results of ROC curve analysis showed that the optimal cutoff value of IPP was 37.5 mmHg, the sensitivity was 56.92%, the specificity was 96.89%, the area under the curve was 0.865, and the 95% CI : 0.704~0.94; the optimal cutoff value for operation time was 59.92 min,the sensitivity is 52.31%, the specificity is 92.86%, the area under the curve is 0.821, and the 95% CI :0.738~0.984. Conclusion Intraoperative renal pelvis pressure and operation time are independent risk factors for postoperative infection of PCNL. Therefore, IPP should be monitored to avoid postoperative infection due to high IPP.