输尿管硬镜联合软镜碎石取石术治疗老年输尿管结石的临床效果及术后发生全身炎症反应综合征的危险因素OA

Objective To explore the rigid ureteroscopy combined with flexible ureteroscopy lithotripsy(FURL)for the treatment of elderly ureteral calculi and risk factors for systemic inflammatory response syndrome(SIRS)after surgery.Methods A total of 200 elderly UC patients who received treatment at Zhengzhou Third People's Hospital from January 2018 to December 2022 were selected and randomly divided into study group(n=100)and control group(n=100)using a random number table method.The control group received semi rigid ureteroscopy treatment,while the study group received ureteroscopy combined with FUL treatment.The first stage calculi clearance rate,perioperative indicators,and urinary function of the two groups were compared,and the incidence of postoperative SIRS was statistically analyzed,univariate analysis and multivariate Logistic regression analysis were performed to identify the risk factors of postoperative SIRS.Results The first stage calculi clearance rate in the study group was higher than that in the control group,with less intraoperative bleeding and shorter duration of hematuria.However,the surgical time and hospitalization time were longer,and the differences were statistically significant(P＜0.05);Compared with 1 month after surgery,the maximum urine flow(Qmax)increased and the International Prostate Symptom Scale(IPSS)score decreased in both groups at 3 months after surgery,the difference was statistically significant(P＜0.05).In addition,the Qmax was higher and IPSS score was lower in the study group than those in the control group at 1 and 3 months after operation,the difference was statistically significant(P＜0.05);Among 100 patients,10 developed SIRS,with an incidence rate of 10.00%;Preoperative white blood cell count(WBC)≥10×109/L,the proportion of patients with preoperative fever due to calculus,intraoperative urine opacity and purulent coating was higher in the occurrence group than those in the non-occurrence group,and the differences were statistically significant(P＜0.05);The results of multivariate logistic regression analysis showed that preoperative fever due to calculus(OR=4.213)and preoperative WBC≥10×109/L(OR=2.122),intraoperative urine opacity and purulent coating(OR=3.616)are independent risk factors for the occurrence of SIRS after ureteroscopy combined with FUL surgery(P＜0.05).Conclusion The application of rigid ureteroscopy combined with FUL in elderly UC patients can promote an increase in primary calculi clearance rate and reduce intraoperative bleeding,shorten the duration of hematuria,improve urination function,but may prolong surgical and hospitalization time;Preoperative WBC≥10×109/L,preoperative fever due to calculus,intraoperative urine opacity and purulent coating are all risk factors for postoperative SIRS.