输尿管镜碎石术围手术期不使用抗生素的可行性研究

Feasibility study of ureteroscopic lithotripsy without antibiotics during the perioperative period

摘要:

目的 探讨输尿管镜碎石术（URL）治疗输尿管中段和下段结石患者，围手术期不使用抗生素预防感染的安全性和可行性。方法 选取2022年7月-2023年1月在贵州医科大学附属医院织金分院行URL治疗的输尿管中下段结石患者180例，随机分成实验组和对照组，每组90例。实验组手术前后均不使用抗生素，对照组采取标准预防，即术前30 min～2 h给予抗生素预防，术后24 h内停用抗生素，所有患者术后2 h复查血常规，术后第1天复查尿常规、血皮质醇水平。无发热的患者术后第1天拔除导尿管，术后第2天出院；发热的患者则继续留置导尿管，使用抗生素，复查血常规。所有患者4周后返院复查并拔出输尿管支架管，比较两组患者术后血白细胞（WBC）、皮质醇水平及感染相关并发症的发生率。结果 依据纳入与排除标准共剔除29例患者，最后实验组86例，对照组65例。所有患者结石完全清除，未见明显残留结石。两组患者术后发热率、术后2 h血WBC分布及术后2 h血WBC、术后第1天尿WBC、术后第4周尿WBC、手术时间、血皮质醇水平比较，差异均无统计学意义（P >0.05）。两组患者术后第1天尿WBC阳性率、尿WBC > 5个/HPF百分率比较，差异均有统计学意义（P <0.05）。两组患者术后4周尿WBC阳性率、尿WBC > 5个/HPF百分率比较，差异均无统计学意义（P >0.05）。结论 术前无泌尿系感染的单纯输尿管中下段结石患者行URL时，围手术期不预防使用抗生素是安全和可行的。

Abstract:

Objective To investigate the safety and feasibility of ureteroscopic lithotripsy (URL) for treating patients with mid and distal ureteral calculi without antibiotic prophylaxis during the perioperative period.Methods From July 2022 to January 2023, the 180 patients with mid and distal ureteral calculi undergoing URL in Zhijin Hospital, Affiliated Hospital of Guizhou Medical University were selected. They were randomly divided into the experimental group and the control group, with 90 cases in each group. The experimental group did not receive antibiotics before or after surgery, while the control group was treated with the standard prophylaxis, where antibiotic prophylaxis was given 30 min to 2 h before surgery and antibiotics were withdrawn within 24 h after surgery. All patients were tested for blood routine 2 h after surgery, and urine routine and blood cortisol concentration on the first day after surgery. For patients without fever, the urinary catheter was removed on the first day after surgery and discharged on the second day after surgery. For those with fever, the urinary catheter was kept while the patients were given antibiotics and retested for blood routine. All patients returned to the hospital 4 weeks later for reexamination and removal of ureteral stents, and the postoperative white blood cell count in the circulation, blood cortisol concentration and incidence of infection-related complications were compared between the two groups.Results According to the exclusion criteria, a total of 29 cases were excluded, with eventually 86 cases in the experimental group and 65 cases in the control group. Ureteral calculi were completely cleared and no remnants were observed in all patients. There was no statistically significant difference in the incidence of postoperative fever, the white blood cell distribution and count in the circulation 2 h after surgery, the white blood cell count in the urine one day after surgery and 4 weeks after surgery, the operative duration, or the blood cortisol concentration between the two groups (P > 0.05). The positive rate of white blood cell in the urine and the percentage of > 5 white blood cells per high power field in the urine one day after surgery were different between the two groups (P < 0.05). There was no difference in the positive rate of white blood cell in the urine and the percentage of > 5 white blood cells per high power field in the urine four weeks after surgery between the two groups (P > 0.05).Conclusion It is safe and feasible to go without antibiotic prophylaxis during the postoperative period when URL is performed in patients with simple mid and distal ureteral calculi without preoperative urinary tract infection.