Analysis Of The Risks Related To Flexible Ureteroscopic Lithotripsy For Renal Calculi Below 2cm Complicated With SIRS

Objective:To analyze the risk factors for the potential SIRS complicated with flexible ureteroscopic lithotripsy(FURL),study and compare the relevance of the risk factors and find out independent risk factors,and provide control measures for FURL complicated with systemic inflammatory response syndrome(SIRS),in an effort to reduce postoperative SIRS occurrence.Methods:The clinical data of patients with renal calculi on FURL in the surgery department of Jiangyin Hospital of Traditional Chinese Medicine for years from January 2018 to January 2019 were retrospectively analyzed,where 145 unilateral single cases with the calculi below 2cm were selected.These data were recorded in EXCEL2019.Fifteen risk factors for FURL potentially complicated with SIRS were selected:F1 sex,F2 age,F3 body mass index(BMI),F4 nistory of diabetes,F5 history of fever(in two weeks)related to calculi,F6 history of calculi surgery on the affected side(ESWL,URL,PCNL),F7 preoperative WBC in urine routine(/ul),F8 preoperative nitrite in urine routine,F9 preoperative midstream urine culture,F10 duration of operation,F11 calculi size,F12 calculi position(middle/lower or lower part),F13 infective calculi(turbidity or pus mosses seen during the operation),F14 diameter of flexible ureteroscope(F11/13 36cm or F12/1446cm),F15 preoperative retention of double-J catheter for two weeks(or not).Two groups were divided according to the occurrence of the complicated SIRS after surgery:A(FURL complicated with SIRS),B(FURL not complicated with SIRS).The data were subject to statistic analysis by SPSS24.0 software(BIM,America).The measurement data were expressed in(X±S).The two independent-sample t tests were applied for comparisons among groups.The attribute data were expressed in relative number.The χ2 test was applied for comparisons among groups.The variables with P<0.05 in the univariate analysis were included in the multivariate analysis where the binary logistic was used for retrospective analysis.Results:15 out of the 145 patients with FURL were observed with FURL complicated with SIRS,a percentage of approximately 10.34%,and 130 cases were for FURL not complicated with SIRS.The univariate analysis:history of diabetes(P<0.001),history of fever in two weeks(P<0.001),preoperative WBC in urine routine(P=0.048),nitrite in urine routine(P<0.001),calculi size(P<0.001)and infective calculi(P=0.003),with greater effects on SIRS complications,were the primary risk factors.The multi-factor binary logistic retrospective analysis:history of diabetes(OR=29.156,95%CL:3.171-268.072,P<0.001),history of fever related to calculi in two weeks(OR=23.298,95%CL:2.534-214.204,P<0.001),nitrite in urine routine(OR=10.530,95%CL:1.101-100.680,P<0.001)and calculi size(P<0.001),infective calculi(OR=7.889,95%CL:1.858-33.495,P<0.001)were the independent risk factors with effects on the occurrence of SIRS complications.Conclusion:"History of diabetes,history of fever related to calculi in two weeks,positive nitrite in urine routine,and calculi size" are the independent risk factors for FURS complicated with SIRS for renal calculi below 2cm.It will greatly increase the risk of postoperative SIRS occurrence.Close monitoring and evaluation of such factors is of vital clinical significance in early diagnosis and treatment of FURL complicated with SIRS.Positive measures for prevention before surgery,careful practice during surgery and timely infection control after surgery would relieve the risk of FURL complicated with SIRS.