Clinical Evaluation Of Negative Pressure Suction Ureteral Access Sheath In Flexible Ureteroscopic Lithotripsy And Analysis Of Sirs Factors After Flexible Ureteroscope Lithotripsy

Objectives:To evaluate the clinical efficacy of negative pressure suction ureteral access shealth(UAS)compared with the traditional UAS in flexible ureteroscope lithotripsy(f-URL).Simultaneously investigate the risk factors of postoperative SIRS(Systemic Inflammatory Response Syndrome)after f-URL and study the effect of negative pressure suction UAS decreasing the incidence of SIRS after f-URL.Methods:111 cases of renal calculi patients were treated with flexible ureteroscopic lithotripsy from December 2015 to March 2017,In Department of Urology,Kunming General Hospital of The PLA.All operations were performed by the same surgeon.Patients were randomly divided into two groups,in the observation group,patients were used the negative pressure suction UAS.While in the control group,patients were treated with traditional UAS in f-URL.Contradistinguish the operation time,stone free rate(SFR),complications and average Hospitalization day of the two groups.Meanwhile,according to SIRS occurred after f-URL,divided the patients into two groups.Single factor analysis and multivariate analysis wree performed to investigate the risk factors of SIRS after f-URL.Results:The postoperative stone free rate was 88.3%and the incidence rate of postoperative SIRS was 8.1%in 111 cases.One patient of postoperative SIRS was deteriorate with urosepsis,after active anti infection and Rehydration,to take a change for the better and leave hospital safely.There have no ureteral perforation or avulsion occurred and no another serious complications occurred.Comparison of parameters between two groups patients after f-URL:The average operation time of the the observation group was 30.31±8.22 min,which shorter than the control group(33.66±7.58)min,there was significant difference(P<0.05).Postoperative SFR of the observation group was 93.7%,which higher than the control group(81.8%),there was significant difference(P<0.05).The incidence rate of SIRS had no significant difference between the observation group and the control group(6.3%VS 10.4%,P>0.05).The average postoperative hospitalization time of the observation group was 3.01±1.20 days,which shorter than the control group(3.79±1.93 days),there was significant difference(P<0.05).Factor analysis of SIRS occurred after f-URL:Univariate analysis showed that preoperative fever,urinary nitrate positive and prolonged operation time correlated with SIRS occurrence after flexible ureteroscope lithotripsy.Multivariate analysis showed that positive urine culture was risk factor for SIRS after flexible Ureteroscopic Lithotripsy.Conclusions:Flexible Ureteroscopic Lithotripsy are safe and efficient procedures for renal stones<2cm.Negative pressure suction UAS’s applying can be more effective to enhance postoperative SFR,while decreasing the incidence of SIRS after f-URL than ordinary UAS pending further study.Positive urine culture is an independent risk factor for SIRS after flexible Ureteroscopic Lithotripsy.For patients with positive urine culture,fever and urinary nitrate positive,positive and effective anti infection treatment,control the operation time and intraoperative surgery as soon as possible is helpful to reduce the postoperative incidence of SIRS.