Analysis Of Risk Factors For SIRS After Lithotripsy With Flexible Ureteroscope

Objective: By analyzing the clinical data of ureteroscopic holmium laser lithotripsy(FURL)in the treatment of road stones,the risk factors of postoperative SIRS were explored in order to reduce the incidence of SIRS after FURL.Methods: Retrospective analysis was performed on the clinical data of 507 patients admitted to our hospital from December 2020 to June 2022 who were clearly diagnosed with upper ureteral calculi or renal calculi accompanied by FURL,among which 464 patients met the inclusion criteria.SIRS occurred in 41 patients and no SIRS in 423 patients.Age,sex,BMI,diabetes,hypertension,surgical history of affected calculi,degree of hydronephrosis,incidence of affected calculi,DJ tube insertion,indwelling time,stone load,preoperative antibiotic use,urinary culture,urinary nitrite,urinary white blood cells,preoperative peripheral white blood cells,neutrophils,lymphocytes,total protein,albumin,surgical side,transfusion Statistical analysis was performed on whether the urinary duct was twisted and whether there was pus moss on the surface of the stone.Independent sample t test was performed for the measurement data conforming to normal distribution,and independent sample Wilcoxon rank sum test was performed for the data not conforming to normal distribution.Count data between groups X 2 test or Fisher exact probability method.Univariate analysis was performed for all included factors,and multivariate Logistic regression analysis was performed for significant factors in the univariate analysis results.p < 0.05 was considered statistically significant.Results: In the univariate analysis,Preoperative indwelling time of DJ tube(p=0.023),diabetes(p=0.016),multiple calculi on affected side(p=0.001),ureteral distortion(p < 0.001),stone load greater than 2cm(p= 0.003),intraoperative abscess and moss(p=0.004),operative duration(p=0.019),no antibiotics used before surgery(p=0.04),urine nitrite positive(p < 0.001),high preoperative urine white blood cell count(p= 0.001),preoperative urine culture positive(p < 0.001),preoperative peripheral blood white blood cell count(p < 0.001),lymphocyte count(p=0.008),monocyte count(p=0.008),platelet count(p=0.016),peripheral blood globulin(p=0.038),A/G(p=0.024)were positively correlated with SIRS after FURL operation.In the multivariate analysis,A history of diabetes mellitus(p=0.043),ureteral distortion(p< 0.001),abscess coating on stone surface(p=0.039),positive preoperative urine culture(p=0.033),high preoperative peripheral blood white blood cell count(p=0.049)were significantly correlated with SIRS after FURL operation.Conclusion: Diabetes mellitus,ureteral distortion,abscess coating on stone surface,positive preoperative urine culture,and elevated preoperative peripheral blood white blood cell count were independent risk factors for SIRS after FURL operation.