| Background and Objective:Urinary stones is one of Urology common diseases in the first place to occupy in urology patients. With the rapid development of China’s economy and the diet, the incidence of urinary tract stones are increasing. Urinary stones can be divided according to the site on the lower urinary tract stones and urinary tract stones, which accounts for about 80% of the upper urinary tract calculi., Its composition varied, can be divided into categories of calcium oxalate, calcium phosphate, uric acid classes, magnesium ammonium phosphate, cystine and the like. Different components of stones in color, shape, texture and the like vary. Wherein the magnesium ammonium phosphate stones is a solution of urease by bacterial infection stones, stones automatic IR analysis showed six amine and phosphate, magnesium carbonate apatite mixed stones that struvite. Percutaneous nephrolithotomy surgery(PCNL) and ureteroscopy lithotripsy(URSL) has become the main method of treatment of upper urinary tract stones. As one of the complications of PCNL infected more and more attention, it was reported postoperative SIRS PCNL were 23.4%or so, some patients and even urinary tract bacteremia, the condition may be serious lead to septic shock, so explore around the factors PCNL operative SIRS has important clinical significance. For a long time multi-cultured according to the preoperative urine bacterial antibiotic selection, but there are systemic inflammatory response syndrome(SIRS) reported negative still occur. In recent years, several studies have shown that the presence of bacteria in the urinary tract stones and urinary bacterial culture there are some differences between species, and the positive rate of bacterial culture stones urine culture, is one of the reasons for postoperative SIRS. This prolonged hospital stay, increased mortality and morbidity. Many domestic and foreign reports that the upper urinary tract calculi before surgery by bacteremia or sepsis caused by systemic inflammatory response syndrome(SIRS) and white blood cells in urine, urine culture surgery, operation time, the number of channels, irrigation lotion dosage and how many other related blood transfusion, but the stones for intraoperative culture results and SIRS little research. Clinical abuse of antibiotics cause increased bacterial resistance to treatment difficult.Methods: Postoperative SIRS were 45 cases, accounting for 21.4% of the total. The average age, sex, BMI, operative time, stone size, stone clearance rate was no significant difference between the two groups, the difference was not statistically significant. A group of urine bacterial culture preoperative renal pelvis urine culture, stone bacterial culture positive rates were 51.1%、68.9%、80%,while in group B positive rate was25.5%、12.7%、11.5%,respectivelythe difference was significant statistically significant(P <0.001). E. coli is the most common pathogen, followed by Enterococcus faecalis, Pseudomonas, Klebsiella, etc. 45 cases of SIRS patients had three cases of septic shock, these three cases before surgery urine culture, urine culture and pelvis intraoperative cultures were positive for stones, and are Escherichia coli. According to the results of bacterial culture after stones select sensitive antibiotics, while giving appropriate supportive treatment, both rehabilitation.Conclusion: preoperative urine culture, urine culture and renal pelvis stones bacterial culture and PCNL between postoperative SIRS closely related. E. coli is the most common pathogen, followed by Proteus mirabilis, Enterococcus faecalis, Candida. Negative preoperative urine culture does not guarantee that the occurrence of postoperative urinary tract infection. Of course, the results are usually cultured stone after 48 h in order to obtain, poor timeliness, lasting more than 48 h after surgery in patients with urinary tract infections and percutaneous nephrolithotomy is helpful to patients next time. |
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