尿管内視鏡ホルミウムレーザー結石破砕術と迷走神経興奮の感染危険因子と発生率の診断に関する解析をコンピュータ断層撮影画像情報健康技術の下で行った

Analysis on the diagnosis of infection risk factors and the incidence of ureteroscopy holmium laser lithotripsy and vagal excitation under computed tomography image information health technology.

• Yuelong Zhang
• Qi Zhang
• Jia Lv
• Dahong Zhang

抄録

尿管内視鏡ホルミウムレーザー結石破砕術後の全身性炎症反応症候群（SIRS）の主な危険因子の分析に基づき、腎結石患者における術後SIRSおよび迷走神経興奮の発生率を低下させるために、対応する予防策を探ることであった。2018年1月から2019年12月までに当院で尿管内視鏡検査ホルミウムレーザー結石破砕術の治療を受けた148例を研究対象とした。手術前の検査は全腹部CT（Computed Tomography）プレーンスキャンと3次元画像を用い、手術後の治療効果を評価するためにKidney, urter, bladder（KUB）を用いた。対象物を大結石群（20mm以上）と小結石群（20mm以下）に分けた。両群の患者の年齢性別による結石部位や結石長・結石径の違いを記録・比較し、両群の結石クリアランス率と合併症を評価した。術後SIRSに関連する危険因子のピアソンカイ二乗検定と多変量ロジスティック回帰分析により、尿管軟鏡ホルミウムレーザー結石破砕術後の患者の迷走神経興奮の発生を分析したところ、両群間で年齢と性別の結石部位に統計的差はなく（P>0.05）、両群間での統計的差はないことがわかった。05）、排石率と術後合併症には両群間で統計的差はなく（P>0.05）、手術時間の差は両群間で統計的に有意であった（P<0.05）。回帰分析によると、手術時間、手術前の途中での尿培養陽性、感染性結石、術後SIRSとの間には有意な正の相関があった（P<0.05）。手術中に迷走神経興奮を起こした患者は78例で、発症率は52.7%であった。その結果、直径20mm以上20mm以下の腎結石に対して、尿管スコープ下でのホルミウムレーザー結石破砕術による治療は臨床的に良好な効果を示した。手術時間、術中部の尿培養陽性、感染性結石は尿管スコープ下ホルミウムレーザー結石破砕術後のSIRS発生の主な危険因子に含まれており、結石を破砕しながら腎神経幹に一定の影響を与えている。

It was to explore the corresponding preventive measures based on the analysis of the main risk factors of systemic inflammatory response syndrome (SIRS) after the ureteroscopy holmium laser lithotripsy, so as to reduce the incidence rate of postoperative SIRS and vagal nerve excitement in patients with renal stones. 148 patients treated with the ureteroscopy holmium laser lithotripsy in our hospital from January 2018 to December 2019 were selected as the research objects. The total abdominal computed tomography (CT) plain scan and three-dimensional imaging were used for examination before surgery, and the Kidney, ureter, bladder (KUB) was used to evaluate the treatment effects after surgery. The objects were divided into the large stone group (>20mm) and the small stone group (≤20mm). The differences in stone sites and stone length and diameter between the age and sex of patients in the two groups were recorded and compared, and the stone clearance rate and complications in the two groups were evaluated. Through the Pearson chi-square test and multivariate Logistic regression analysis of the risk factors related to postoperative SIRS, the occurrence of vagal excitation in patients after ureteral soft mirror holmium laser lithotripsy was analysed, it found that there was no statistical difference in stone sites of age and sex between the two groups (P>0.05), and there was no statistical difference in stone clearance rate and postoperative complications between the two groups (P>0.05), while the difference in operation time between the two groups was statistically significant (P<0.05). According to the regression analysis, there was a significant positive correlation between the time of operation, positive urine culture in the middle before operation, infectious calculus, and postoperative SIRS (P<0.05). 78 patients suffered from vagal excitation during the surgery, and the incidence rate was 52.7%. The results showed that the treatment of kidney stones with a diameter more than 20mm and no more than 20mm by holmium laser lithotripsy under ureter-scope had good clinical effect. The operative time, positive urine culture in the middle part of the operation, and infectious stones were included in the main risk factors for the occurrence of SIRS after ureter-scope holmium laser lithotripsy and has a certain impact on the renal nerve trunk while crushing stones.

Copyright © 2020. Published by Elsevier B.V.