经皮肾镜碎石取石术后发热原因及治疗分析

目的：探讨引起经皮肾镜取石术（PCNL）后发热的因素及防治措施。方法回顾性分析2011年1月至2012年12月本院收治的158例行PCNL患者的临床资料，分析术后体温＞38.5℃患者的年龄、结石大小、手术时间、术前是否尿路感染、术后是否引流不畅等因素与发热的关系以及相应的治疗措施。结果158例患者中31例（19.6%）出现术后体温升高，其中14例患者术前存在感染，术后引流不畅导致发热者11例，结石直径＞3.0 cm组患者术后发热率为47.61%，≤3.0 cm组为9.48%（χ^2=28.436，P =0.000）；手术时间＞90 min组患者术后发热率为25.80%，≤90 min组为10.76%（χ^2=5.486，P=0.019）；术前存在感染组患者发热率为40.00%，不存在感染组为13.82%（χ^2=11.840，P=0.001）；术后引流不畅组发热率为84.61%，引流通畅组为13.79%（χ^2=37.944，P=0.000）；组间发热率比较差异均具有统计学意义（P ＜0.05）。而不同年龄、同侧上尿路手术史、合并糖尿病组间发热率比较差异无统计学意义。发热患者使用抗菌药物，保持引流通畅等治疗后痊愈。结论发热是PCNL术后常见的并发症，术前尿路感染、结石较大、手术时间长和术后引流不畅是发热的主要原因。保持引流通畅及使用有效抗菌药物是最主要的处理方法。

Causes and management of fever after percutaneous nephrolithotomy

Objective To investigate the causes of fever after percutaneous nephrolithotomy （PCNL） and its mangement. Methods The clinical Datas of 158 cases undergoing PCNL were retrospectively analyzed from January 2011 to December 2012. Results There were 31 among 158 cases （19.6%） had fever （over 38.5 ℃）, 14 cases had urinary tract infection before operation and 11 cases had fever because of poor drainage after surgery. The fever rates in cases with stone diameter〉3 cm and≤ 3 cm were 47.61%and 9.48%（χ^2=28.436, P=0.000）, respectively. The operative time〉90 min and ≤ 90 min were 25.80% and 10.76%, respectively （χ^2= 5.486, P= 0.019）. The Preoperative urinary tract infection group was 40%, and it was 13.82%in noninfection group （χ^2=11.840, P=0.001）. The fever rates in cases with poor drainage and lfuent drainage were 84.61%and 13.79%, respectively （χ^2=37.944, P=0.000）. There were signiifcant differences between each groups （P〈0.05）, and there were no signiifcant signiifcances in cases with different age, history of ipsilateral upper tract surgery and diabetes mellitus. All fever cases recovered after treatment with antibiotics and lfuent drainage. Conclusions Fever is a common complication after PCNL. Preoperative urinary tract infection, larger stone size, longer operation time and poor drainage are major causes of fever. Unobstructed drainage and use of effective antibiotics are the main treatment methods.