| Objective To evaluate the serum endotoxin determination in lithotripsy percutaneous nephrolithotomy(PCNL) in the diagnosis of postoperative infectious complications,and systematic reviews the clinical value of different indicators in the diagnosis of postoperative systemic inflammatory response syndrome(SIRS),and evaluate the efficacy and safety of PCNLin the treatment of renal infectious stones with the Holmium YAG Laser.Methods In the first stage,122 cases with kidney stone were admitted to compl ete Percutaneous Nephrolithotomy(PNL) in the B ultrasound-guided, we detected serum endotoxin level of the preoperative and postoperative serum samples,and analysis the relationship betwee serum endotoxin levels and postoperative in fection,and in the second stage 334 patients of kidney stones from March 2013 to November 2014 patients were chose for candicates,they all completed percuta-neous nephrolithotomy lithotripsy(PCNL) under ultrasound guided. All patients had blood detection after operation,we recorded serum endotoxin(ET) and proca lcitonin(PCT), C-reactive protein(CRP), white blood cell count(WBC) level values, Then analysis the relationship between different indicators with postoperati ve inflammatory response syndrome(SIRS) and its clinical value.In the third The third stage, 127 cases of with kidney infectious stones were treated by PCNL,treatment of patients with infectious stones, we evaluate level changes serum of en dotoxin the efficacy and safety of PCNL in the treatment of renal infectious stones with t he Holmium YAG Laser.Results In our study, All patients were successfully operated. in the first stage19 patients got fever postoperative,which divided fever group,103 cases of normal group, divided control group,according to the testing standards set less than 0.075EU/ml was negative toxins,rise to positive values,control group of preoperative measured serum endotoxin average of 0.023±0.017EU/ml, the positive rate was 3.9%, postoperative serum endotoxin was 0.090±0.054EU/ml, the positive rate was 39.8%, that the fever group preoperative serum endotoxin average of 0.031±0.029EU/ml, the positive rate of 10.5%, postoperative serum endotoxin was 0.728±0.534EU/ml,the positive rate of 89.4%, Contrast found that preoperative serum endotoxin levels in the two groups was not significantly different(p> 0.05)),but the postoperative were significantly higher in the fever group than control group(p <0.05), of which 6 cases patients with persistent high fever and chills,the serum samples measured toxins average of 0.650±0.403EU/ml, were all positive values, and considered the combined presence of endotoxemia. In the second stage,eight cases of severe kidney infection were except from our study for a second stage sugery,others were all successfully operated, according to the diagnostic criteria of SIRS, they wre divided into non-SIRS group(295 cases) and SIRS group(31 cases), postoperative ET,PCT,CRP and WBC detection of non-SIRS group were 0.076+.0.055EU/ml、0.425±0.342ug/L、13.91±7.99mg/L、10.41±2.6×109/L,while SIRS group were 0.917±0.829EU/ml、4.3663±4.17ug/L、36.12±25.34mg/L、14.93±5.26×109,The study found that ET and PCT, CRP, WBC levels were significantly increased(P <0.05), where the area under the ROC curve of serum endotoxin(AUC) of 0.948, sensitivity of optimal cutoff values was 93.5%, specificity 87.6%, the area under the ROC curve index PCT(AUC) of 0.937, sensitivity of optimal cutoff values was sensitivity 90.3%, specificity 85.2%,CRP and WBC is poor. In the third stage,105 cases were treated in one stage,10 patients received a second stage PNCL due to residual stones>1cm in diameter,and 12 patients underwent ESWLor medicine due to residual calculi<1 cm in diameter.The total stone clearance rate was 91.3%, The total length of hospital stay was 10-17 days,13 days for averange,one month after operation,we checked KUB, 116 cases had no obvious residual stones, total clearance rate.was 91.3%,22 patients got postoperative fever, 8 cases of shiver high fever(>39.5 ℃), 6 cases of low temperature(<38.0 ℃), 22 cases of postoperative fever in patients with serum toxin detected, there are 15 cases(15 / 22,68.18%) patients with elevated serum endotoxin level, considering endotoxemia,2 patient developed bacteremia,1 patient treated by embolotherapy for persistent renal bleeding,and 1 patient got urinary leak, other cases finished operation smoothly.No patients showed urosepsis, abdominal visceral injury, abdominal effusion, pleural effusion, pneumothorax, and renal arteriovenous fistula and other severe complications.Conclusion Detection of serum endotoxin levels in percutaneous nephrolithotomy is an important parameter for the diagnosis and monitoring of postoperative infection,And serum endotoxin is superior to other indicators in the diagnosis of postoperative systemic inflammatory response syndrome(SIRS),which has advantages of rapid, simple and high sensitivity, suitable for early diagnosis, especially the diagnosis of postoperative SIRS and has certain guiding significance for clinical therapy. Also,PCNL combined with the Holmium YAG Laser is a safe and effective procedure for treating renal infectious stones,which has the advantage of less stone residual,injures and complications. |
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