输尿管软镜碎石术后尿路感染的危险因素分析及预测模型构建

目的:分析影响输尿管软镜碎石术后尿路感染的危险因素,建立列线图预测模型。方法:采用便利抽样法,选取2019年4月—2021年7月阜南县人民医院收治的327例行输尿管软镜碎石术患者为研究对象,根据术后30 d内是否发生尿路感染分为感染组与未感染组,采用多因素logistics回归模型筛选术后尿路感染的独立影响因素,基于独立影响因素建立列线图预测模型,并评估模型的区分度与准确度。结果:输尿管软镜碎石术患者术后尿路感染发生率为14.37%（47/327）;多因素logistic回归分析显示,术前尿路感染、合并糖尿病、留置尿管时间>7 d、肾盂内压>30 mmHg为影响术后尿路感染的独立危险因素（P<0.05）,预防性应用抗菌药物为保护性因素（P<0.05）;基于输尿管软镜碎石术后尿路感染的独立影响因素建立列线图预测模型,内部验证结果显示列线图模型的校准曲线预测值与实际值基本一致,Hosmer-Lemeshow拟合优度检验χ²=8.199,P=0.315,ROC曲线下面积为0.805（95%CI:0.729～0.877）,DCA曲线分析阈值范围为0...     

ICU患者外周动脉导管非计划性拔管风险预测模型的构建及验证

目的 构建并验证ICU患者外周动脉导管非计划性拔管的风险预测模型。方法 选择300例(建模组)ICU留置外周动脉导管患者作为研究对象,回顾性收集患者相关资料,采用单因素分析、logistic回归分析筛选非计划性拔管的危险因素,构建风险预测模型。选择117例ICU留置外周动脉导管患者对风险预测模型进行验证。结果 建模组23.00%患者发生非计划性拔管。年龄≥65岁,并存高血压、静脉血栓栓塞症,置入部位为桡动脉及置入导管为静脉留置针是ICU患者外周动脉导管非计划性拔管的高危因素（均P<0.05）。预测模型的ROC曲线下面积为0.888。模型验证结果显示,ROC曲线下面积为0.903,灵敏度为86.2%,特异度为85.2%,约登指数为0.714。结论 构建的ICU患者外周动脉导管非计划性拔管的风险预测模型预测效果良好,可为医护人员及时采取预防性护理措施提供依据。     

个体化预测上尿路结石术后留置双J管致严重下尿路症状风险模型的建立与验证

目的：构建可个体化预测上尿路结石术后留置双J管致严重下尿路症状（LUTS）的风险Nomogram模型,并对模型的预测能力进行验证。方法：回顾性分析2020年3月至2021年5月于我院行上尿路结石术后留置双J管的317例例患者作为研究对象,收集患者临床资料,采用单因素和多因素Logistic回归分析发生严重LUTS的危险因素,并建立Nomogram模型。结果：糖尿病[OR=2.555,95%CI:1.072-6.092]、双J管型号较粗（Fr6型）[OR=2.819,95%CI:1.456-5.459]、双J管长度≥26 cm[OR=2.645,95%CI:1.411-4.959]、留置时间≥14 d[OR=2.573,95%CI:1.373-4.823]和输尿管异常[OR=2.616, 95 CI:1.384-4.945]是上尿路结石术后留置双J管致严重LUTS的独立危险因素（P<0.05）。模型验证结果显示,C-index为0.757(95%CI:0.721-0.793),校准曲线趋近于理想曲线,ROC曲线的AUC为0.761(95%CI:0.726-0.796),10%～66...     

上尿路结石经皮肾镜取石术后尿路感染的特点及其危险因素分析

目的 探讨上尿路结石经皮肾镜取石术（PCNL）后尿路感染的特点及其危险因素。方法 回顾性分析2020年6月至2022年6月接受PCNL治疗的156例上尿路结石患者的临床资料，记录术后尿路感染发生情况及病原菌分布特点，采用多因素Logistic回归分析尿路感染的危险因素。结果 156例患者中，有23例术后发生尿路感染，发生率为14.74%;23例感染患者并检测出病原菌26株，其中革兰氏阴性菌占比69.23%，革兰氏阳性菌占比30.77%；单因素分析中，感染与未感染患者年龄、糖尿病、鹿角形结石、结石表面积、术中通道类型、手术时间、术后导尿管留置时间比较，差异有统计学意义（P<0.05）；多因素Logistic回归分析显示，年龄、糖尿病、鹿角形结石、结石表面积、术中通道类型、手术时间、术后导尿管留置时间均是上尿路结石PCNL术后尿路感染的危险因素（P<0.05）。结论 上尿路结石PCNL术后尿路感染发生的危险因素较多，临床上应针对相关因素提早加强干预，以期减少尿路感染发生率。     

DMIST量表预测糖尿病足溃疡愈合后1年内复发的价值及预测模型构建

目的 探讨糖尿病足溃疡（DFU）愈合后1年内复发的影响因素并构建预测模型,评估DMIST量表预测DFU愈合后1年内复发的应用价值。方法 收集2020年1月至2021年6月于山东第一医科大学附属省立医院接受治疗的172例DFU患者的临床资料,根据愈合后1年随访期内DFU是否复发将患者分为复发组（n=51）和DFU组（n=121）。比较两组患者的临床特征、血液指标和DMIST量表评分;采用多因素Cox回归模型分析DFU愈合后1年内复发的影响因素,构建预测模型并验证模型的准确性;分析DMIST量表对DFU愈合1年内复发的预测价值,并通过溃疡复发Kaplan-Meier风险曲线和受试者工作特征（ROC）曲线进行验证。结果 两组患者的踝肱指数（ABI）、合并冠心病比例、Wagner分级以及DMIST量表中的溃疡深度评分、感染评分、坏死组织类型评分、皮下窦道或潜行创面评分、总分比较,差异均有统计学意义（P﹤0.05）。多因素分析结果显示,冠心病、溃疡深度评分、皮下窦道或潜行创面评分均是DFU愈合后1年内复发的危险因素,ABI是DFU愈合后1年内复发的保护因素（P﹤0.05）。ROC曲线和预测模型的...     

术前CA242、HGB及INR用于转移性结直肠癌患者手术疗效预测临床效能分析

目的 探讨术前糖类抗原242(CA242)、血红蛋白（HGB）及国际标准化比值（INR）用于转移性结直肠癌患者术后复发风险预测临床效能，为早期准确识别术后早期转移高危人群及制定针对性干预方案提供借鉴。方法 回顾性纳入本院2016年1月至2020年1月收治行手术治疗转移性结直肠癌患者共112例，根据术后随访24个月是否转移分为转移组（50例）和未转移组（72例）；采用单因素和多因素法评估转移性结直肠癌患者术后复发独立危险因素，描绘受试者工作特征（ROC）曲线分析上述独立危险因素用于转移性结直肠癌患者转移风险预测临床效能。结果 单因素分析结果显示，ECOG评分、CA242水平、HGB水平及INR水平均可能与转移性结直肠癌患者术后复发有关（P<0.05）;Logistic回归模型多因素分析结果显示，低ECOG评分、高CA242水平、低HGB水平及高INR水平均是转移性结直肠癌患者术后复发独立危险因素（P<0.05）;ROC曲线分析结果显示，CA242水平、HGB水平及INR水平均可用于转移性结直肠癌患者术后复发风险预测，且三者联合预测效能优于两者联合及单一指标（P<0.05...     

甲状腺乳头状癌中央区淋巴结转移的影响因素及预测模型建立

目的 ：分析甲状腺乳头状癌（PTC）中央区淋巴结转移（CLNM）患者转移的相关因素，并建立CLNM可视化预测模型。方法：选取272例PTC患者（训练集），按照术后病理结果所示CLNM转移情况将其分为转移组和未转移组，对比两组临床资料、影像特征。通过多因素Logistic回归模型分析影响PTC发生CLNM的相关因素，并使用Nomogram建立可视化预测模型。另选取81例PTC患者（验证集）验证模型效能。结果：训练集272例PTC患者中，54例（19.85%）经病理组织学检查明确存在CLNM。Logistic多因素分析示，合并微钙化、血流分级、不均匀强化、囊性变均为PTC发生CLNM的独立危险因素（P<0.05），而年龄越大是保护因素（P<0.05）。外部验证集验证结果显示，AUC为0.905。决策曲线分析结果表明该模型具有较大的临床应用价值。结论：PTC患者发生CLNM的影响因素众多，基于年龄等多项临床资料和影像学检查结果建立的预测模型能够准确预测患者CLNM发生情况。     

胰十二指肠切除术后临床相关胰瘘风险预测模型构建及验证

背景与目的：随着外科技术的进步以及临床医师不断完善手术方式,胰十二指肠切除术（PD）的手术死亡显著减少,但术后并发症发生率仍居高不下,其中最常见和最严重的是术后胰瘘（POPF）。因此,本研究探讨PD后发生临床相关胰瘘（CR-POPF）的危险因素并开发风险预测模型。方法：回顾性收集2015年1月—2021年7月宁夏医科大学总医院肝胆外科行PD治疗的365例患者临床资料。通过计算机产生随机数的方法以7∶3比例随机分为建模组和验证组,对建模组采用单因素及多因素Logistic回归分析确立CR-POPF的独立危险因素,构建临床预测模型,以列线图进行可视化呈现;利用受试者工作特征（ROC）曲线评价区分度,并通过Bootstrap重复自抽样法进行内部验证,绘制校准曲线评价校准度;将验证组代入模型绘制ROC曲线和校准曲线,验证模型的预测效能。结果：单因素分析结果显示,性别、BMI、腹部手术史、主胰管直径、胰腺质地、中性粒细胞计数、单核细胞计数、淋巴细胞计数与单核细胞计数比值、术后乳酸与CR-POPF明显有关（均P<0.05）;多因素二元Logistic回归分析显示,男性（OR=2.896,95...     

儿童斜疝腹腔镜疝囊高位结扎术后复发的个体化风险预测模型的建立

目的探究个体化预测腹腔镜下儿童斜疝疝囊高位结扎术后复发的风险预测模型的建立。 方法收集2017年10月至2019年10月于新疆医科大学第一附属医院行腹腔镜疝囊高位结扎术的腹股沟斜疝194例患儿的临床资料。基于是否复发将患儿分为复发组（31例）和未复发组（163例）,复发组患儿均采取开放式疝囊高位结扎术进行二次手术治疗。采用单因素和Logistic回归多因素分析术后复发的危险因素,并建立相关列线图模型。 结果单因素分析显示：2组性别、病程、是否合并隐匿疝、有无嵌顿疝、是否疝环粘连、发病部位、疝囊大小资料间差异无统计学意义（P>0.05）。2组年龄、小儿肥胖症、内环口大小和结扎线类型间差异有统计学意义（P<0.05）。多因素分析显示：年龄≥6岁、小儿肥胖症、内环口大小≥3 cm、可吸收线结扎是腹腔镜下儿童斜疝疝囊高位结扎术后复发的独立危险因素（P<0.05）。模型验证结果显示：C-index为0.744,校准曲线趋近于理想曲线,表明具有良好的预测精度,受试者工作特征曲线下面积为0.760（95% CI：0.715~0.803）,表明具有良好的区分度。 结论临床应对年龄≥6岁、小儿肥胖症、内环口大小≥3 cm、可吸收线结扎的腹股沟斜疝患儿予以重视,警惕其在腹腔镜下疝囊高位结扎术后出现复发,据此建立的列线图模型能够有效预测腹腔镜下儿童斜疝疝囊高位结扎术后的复发风险。     

术前淋巴细胞与C反应蛋白比值在预测胆囊癌术后复发中的应用及其临床价值

背景与目的：系统性炎症与大多数恶性肿瘤的发生发展密切相关,炎症相关评分的研究为改善癌症患者风险分层和患者预后提供了有效的预测信息。但目前尚缺乏关于炎症评分与胆囊癌（GBC）患者术后复发风险关系的研究。因此,本研究探讨术前淋巴细胞计数与C反应蛋白（CRP）比值（LCR）与胆囊癌患者术后复发的关系,并建立预测GBC术后复发风险的列线图模型。方法：回顾性分析中国人民解放军联勤保障部队第九〇〇医院2009年5月—2021年12月接受手术治疗的103例GBC患者的临床资料,绘制LCR预测术后复发的受试者工作特征曲线（ROC）,确定最佳临床临界值。根据临界值将GBC患者分为高LCR组和低LCR组,分析两组患者临床病理特征的差异及影响患者术后复发的危险因素,并根据危险因素的回归系数绘制相应的GBC患者术后复发的列线图预测模型,并通过校准曲线及一致性曲线进行验证。Kaplan-Meier法绘制生存曲线,并用Log-rank检验比较两组患者的总生存时间（OS）和无复发生存时间（RFS）的差异。结果：术前LCR预测GBC患者术后复发的ROC曲线下面积为0.681 (95%CI=0.560～0.802,P&...     

Recurrence factors in patients with Keratinizing squamous metaplasia of the bladder after surgical management: a single-center retrospective study

BackgroundKeratinizing squamous metaplasia (KSM) is a clinically heterogeneous disease that lacks research that provide definitive recurrent risk factors. Therefore, we identified the recurrence factors in patients with KSM of the bladder after transurethral resection (TUR). We also attempted to investigate the association between KSM and bladder cancer.MethodsClinical information of 257 patients diagnosed with KSM who underwent TUR in Xiangya Hospital from January 2010 to November 2018 were retrospectively collected. Clinical information was available for follow-up of 223 patients. To determine the risk factors for recurrence, we conducted univariate and multivariate cox regression analysis respectively. To explore the association between KSM and bladder cancer, we used clinical follow-up data.ResultsThe median follow-up time is 49 (IQR, 12–121) months. Five-year recurrence-free rate (RFR) and 1-year RFR were 86.1% and 91.9%, respectively. Thirty-one patients (13.9%) relapsed of KSM after a median follow-up of 49 months (range, 12–121 months), and none of them developed subsequent bladder cancer. Univariate Cox analysis indicated that urinary tract infection [hazard ratio (HR) =2.111; 95% confidence interval (CI): 1.043–4.271; P=0.038], and atypical urothelial hyperplasia of the bladder (HR =4.191; 95% CI: 2.006–8.756; P<0.001) were significant recurrence factors. Multivariate Cox analysis suggested that atypical urothelial hyperplasia of the bladder (HR =3.506; 95% CI: 1.663–7.392; P=0.001) was the independent risk factor for postoperative recurrence of KSM.ConclusionsThe recurrence rate in patients with KSM was about 13.9%, and atypical urothelial hyperplasia of the bladder was the independent risk factor in patients with KSM recurrence. In cases with bladder atypical urothelial hyperplasia, close follow-ups are necessary. Also, we demonstrated that KSM did not increase the subsequent risk of bladder cancer.     

Prophylactic radical cystectomy for the management of keratinizing squamous metaplasia of the bladder in a man with tetraplegia

BACKGROUND/OBJECTIVE: To report a case of keratinizing squamous metaplasia of the bladder treated with radical cystectomy. DESIGN: Case report and discussion of management options. METHODS: Keratinizing squamous metaplasia of the bladder is a rare entity that can result from chronic irritative stimuli involving the bladder. It is considered a premalignant condition associated with invasive squamous cell carcinoma. A case report is presented describing the diagnosis and management of keratinizing squamous metaplasia of the bladder in a tetraplegic man with a chronic indwelling urinary catheter. RESULTS: Radical cystectomy with an Indiana continent reservoir was performed after cystoscopy with biopsy confirmed keratinizing squamous metaplasia. Final pathology revealed focal erosion and diffuse keratinizing squamous metaplasia of the bladder with prostatic adenocarcinoma as an incidental finding. CONCLUSIONS: Patients with spinal cord injury who use indwelling catheters for bladder management are at higher risk of developing keratinizing squamous metaplasia. Surveillance for early detection of this entity is recommended. Prophylactic cystectomy is sometimes warranted; however, observation and frequent cystoscopic surveillance to identify potential malignant transformation can be an alternative strategy. An interdisciplinary approach is recommended before consideration of bladder resection.     

“无管化”微通道经皮肾镜取石术治疗上尿路结石68例临床观察

目的 评价“无管化”微通道经皮肾镜取石术(MPCNL)治疗上尿路结石临床疗效、安全性和可行性.方法 用“无管化”MPCNL方法治疗上尿路结石患者68例,其中肾结石患者41例和输尿管上段结石27例,结石最大直径均≤3 cm,术后不留置肾造瘘管,取石后常规留置双“J”管和导尿管.结果 68例患者术中出血量约30～80 mL,平均55 mL,手术时间35～75 min,平均(52.5±3.3)min,结石清除率为95.6％(65/68),3例结石残留(术后2d复查B超提示残留结石直径为3.1、2.8、2.5 mm),术后未出现尿外渗、肾周血肿、感染等并发症;术后住院时间3～5d,平均(4.0±1.2)d,出院后1个月和3个月复查,无结石复发,肾周无肾性囊肿,肾积水均有不同程度减轻.结论 “无管化”MPCNL由于选择了合适的患者,降低了术中的风险性,结石清除率高、术中出血量少、术后并发症少、恢复快,因此是安全有效且可行的,具有非常肯定的临床应用价值,值得进一步推广应用.     

Indwelling Urinary Catheter for Total Joint Arthroplasty Using Epidural Anesthesia

BackgroundThe objective of this study was to evaluate if not placing an indwelling urinary catheter leads to a higher potential for adverse genitourinary (GU) issues after total joint arthroplasty (TJA) under epidural anesthesia.MethodsThree hundred thirty-five consecutive patients who underwent primary TJA using epidural anesthesia were retrospectively reviewed. The initial 103 patients received a preoperative urinary catheter, which was maintained until the morning of postoperative day 1. The subsequent 232 patients did not receive a preoperative urinary catheter. Demographics, medical complications, GU complications, and length of stay were compared between groups.ResultsCompared between catheter and noncatheter groups, there were no differences in demographics including age, gender, or laterality of surgery. There was a difference in type of surgery (total knee arthroplasty vs total hip arthroplasty) (P = .008). There was no difference in American Society of Anesthesiologists score, but with a difference in body mass index (P = .01). There were no differences in GU complications among patients with benign prostatic hyperplasia or prostate cancer. However, among patients with a history of prostate disorders (benign prostatic hyperplasia or prostate cancer), urinary tract infection rate was higher in catheter group (P = .023). Postoperative GU complications were associated with increased median age in years and increased average length of stay in days.ConclusionPatients undergoing TJA under epidural anesthesia demonstrate no increased risk of postoperative urological complications without the placement of preoperative indwelling urinary catheter. The routine use of preoperative catheters can be reconsidered for this mode of anesthesia.Level of EvidenceLevel II, retrospective comparative study.     

加速康复流程下人工全膝关节置换术后留置尿管的危险因素分析

目的探讨加速康复流程下人工全膝关节置换术(total knee arthroplasty,TKA)患者术后留置尿管的危险因素。方法以2017年1月-2018年8月全麻下初次单侧TKA患者为研究对象,其中205例符合选择标准纳入研究。收集患者临床资料,包括年龄、性别、体质量指数,术前关节活动度、美国特种外科医院(HSS)评分、美国麻醉医师协会(ASA)评分、疾病类型、合并症、血红蛋白、血细胞比容、血容量,手术时间及时刻、术后是否留置引流管、术中失血量、总失血量,术前、术中、术后补液量以及手术当天总补液量,手术当天小便量。采用单因素及logistic回归分析术后留置尿管的危险因素。同时,比较留置或未留置尿管患者术后住院时间以及围术期并发症发生情况,包括肌间静脉血栓、下肢深静脉血栓、肺栓塞形成,切口红肿渗出,电解质紊乱,恶心呕吐,尿路感染。结果205例患者中41例术后留置尿管,发生率为20.0%。单因素分析显示,年龄、性别、术后留置引流管、手术当天总补液量和小便量是初次单侧TKA术后留置尿管的影响因素(P<0.05)。多因素分析显示,男性和手术当天小便量多是初次单侧TKA术后留置尿管的危险因素(P<0.05)。与留置尿管组相比,未留置尿管组患者术后住院时间明显缩短、尿路感染发生率明显降低,差异有统计学意义(P<0.05);两组其他围术期并发症发生率差异均无统计学意义(P>0.05)。结论加速康复流程下,男性和手术当天小便量更多的患者在全麻初次单侧TKA后需留置尿管的风险更高。     

Prophylactic Radical Cystectomy for the Management of Keratinizing Squamous Metaplasia of the Bladder in a Man With Tetraplegia

Abstract

Background/Objective: To report a case of keratinizing squamous metaplasia of the bladder treated with radical cystectomy.

Design: Case report and discussion of management options.

Methods: Keratinizing squamous metaplasia of the bladder is a rare entity that can result from chronic irritative stimuli involving the bladder. It is considered a premalignant condition associated with invasive squamous cell carcinoma. A case report is presented describing the diagnosis and management of keratinizing squamous metaplasia of the bladder in a tetraplegic man with a chronic indwelling urinary catheter.

Results: Radical cystectomy with an Indiana continent reservoir was performed after cystoscopy with biopsy confirmed keratinizing squamous metaplasia. Final pathology revealed focal erosion and diffuse keratinizing squamous metaplasia of the bladder with prostatic adenocarcinoma as an incidental finding.

Conclusions: Patients with spinal cord injury who use indwelling catheters for bladder management are at higher risk of developing keratinizing squamous metaplasia. Surveillance for early detection of this entity is recommended. Prophylactic cystectomy is sometimes warranted; however, observation and frequent cystoscopic surveillance to identify potential malignant transformation can be an alternative strategy. An interdisciplinary approach is recommended before consideration of bladder resection.     

输尿管软镜碎石联合留置双J管预防上尿路结石并发急性肾盂肾炎的可行性和安全性分析

目的分析输尿管软镜碎石联合留置双J管预防上尿路结石并发急性肾盂肾炎的可行性和安全性。方法选取2017年5月至2018年10月在本院治疗的上尿路结石患者86例,随机分为留置组和非留置组,各43例。所有患者均采用输尿管软镜碎石治疗,留置组术前留置双J管,非留置组术前不留置双J管。比较两组患者一次性软镜和镜鞘置入成功率,术后1个月净石率、术后并发急性肾盂肾炎等并发症的发病率和治疗的满意度。结果留置组患者一次性软镜和镜鞘置入成功率,术后1个月净石率均明显高于非留置组(P<0.05),留置组患者术后并发急性肾盂肾炎等并发症的发病率均低于非留置组(P<0.05)。留置组患者治疗的满意度高于非留置组(P<0.05)。结论输尿管软镜碎石联合留置双J管治疗上尿路结石疗效好,结石清除率高,术后并发急性肾盂肾炎的发病率低,具有良好的可行性和安全性。     

在尿路结石患者中预测草酸钙结石列线图的建立与应用

目的建立和应用个性化的列线图模型,探讨列线图预测尿路结石患者中草酸钙结石的准确性及可行性。方法回顾性分析2017年1月1日至2018年12月31日在中山大学附属第五医院接受手术治疗的298例泌尿系结石患者资料,以7∶3的比例随机分为建模组和验证组,基于建模组采用最小绝对值收敛和选择算子回归(Lasso)模型及多变量Logistic回归分析选择草酸钙结石的最佳预测特征,根据最佳预测特征以列线图的形式构建预测模型。通过C指数、校准曲线和决策曲线分别评估列线图的辨别力、校准和临床实用性,并基于验证组对外部验证进行评估。结果在LASSO模型中选择的最佳预测特征包括结石位置、甘油三酯(TG)和尿比重(SG)。将以上最佳预测特征和性别、年龄一起建立列线图模型后,建模组和验证组的C指数分别为0.706、 0.603,表明模型具有良好的辨别能力。校准曲线中标准曲线与预测校准曲线贴合良好,提示校正效果良好。决策曲线分析表明,在草酸钙结石可能性阈值为31%时使用该列线图可以在临床上获益。结论本研究建立的列线图预测模型可有效预测草酸钙结石,有助于筛选和早期识别草酸钙尿路结石的高危患者,对泌尿科医师进行临床治...     

无管化微通道经皮肾镜取石术与输尿管镜碎石治疗上尿路结石对比研究

［摘要］ 目的 探究对比无管化微通道经皮肾镜取石（PCNL）与输尿管镜碎石（URL）治疗上尿路结石的效果。方法 选取2017年2月～2019年3月我院60例上尿路结石作为研究对象,依据手术方案不同分为PCNL组与URL组,各30例。统计对比两组手术相关指标（手术用时、Ⅰ期结石清除率、血红蛋白减少量、尿管留置时间及住院时间）、术后疼痛程度、镇痛药物使用率及术后并发症发生率。结果 两组手术用时、术后血红蛋白减少量、尿管留置时间及住院时间相比,无明显差异（P>0.05）;PCNL组I期结石清除率较URL组高（P<0.05）;PCNL组术后疼痛评分、镇痛药物使用率与URL组相比,均无明显差异（P>0.05）两组术后并发症发生率相比,无明显差异（P>0.05）。结论 相较于URL,无管化微通道PCNL治疗对上尿路结石患者,I期结石清除率较高,不会增加患者术后疼痛程度、镇痛药物使用率及术后并发症发生率,且未延长术后尿管留置时间。     

Bladder management after total joint arthroplasty

This study was undertaken to determine the impact of an indwelling Foley catheter on bladder dysfunction and incidence of urinary tract infections after total joint arthroplasty. A prospective randomized controlled trial was conducted assigning use of an indwelling Foley catheter (group 1) or intermittent catheterization (group 2) for 48 hours following operation. Postoperative cultures were obtained on days 2 and 5, and the number of intermittent catheterization events and void and catheterization volumes were recorded. Concurrent cost-effectiveness analysis was conducted. One hundred nineteen of 174 consecutive patients having elective primary total joint arthroplasty completed the study. Five of 62 patients (8%) in group 1 and 7 of 57 patients (12%) in group 2 developed urinary tract infections (NS, P = .45). Twenty patients (35%) in group 2 and 12 (19%) in group 1 required straight catheterization for inability to void 48 hours after surgery (P = .05). Seventeen patients (35%) in group 2 and eight patients (16%) in group 1 required straight catheterization after epidural analgesia was discontinued (P = .024). Bladder management by indwelling Foley catheter saved more than 150 minutes of direct nursing contact per patient and $3,000 in total hospital costs. Indwelling Foley catheters reduced the frequency of postoperative urinary retention, were less labor intensive than intermittent straight catheterization, and were not associated with an increased risk of urinary infection. In the setting of epidural anesthesia and postoperative analgesia for total joint arthroplasty, management by indwelling catheter is a cost-effective strategy to facilitate postoperative return of normal bladder function.