無腎管經皮腎造瘻取石術術後敗血症及全身性發炎症候群之統合分析
黃品叡、周詠欽、沈正煌、林昌德、鄭明進
戴德森醫療財團法人嘉義基督教醫院 外科部 泌尿科
Meta-analysis of postoperative sepsis and systemic inflammatory response syndrome of positive stone bacterial culture for tubeless mini-percutaneous nephrolithotomy
Pin-Jui Huang, Yeong-Chin Jou, Cheng-Huang Shen, Chang-Te Lin,Ming-Chin Cheng
Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose: To evaluate the postoperative sepsis and systemic inflammatory response syndrome (SIRS) of positive stone bacterial culture for patients receiving tubeless mini-percutaneous nephrolithotomy (PCNL).
Material and Method: A comprehensive Pubmed and Embase database search was performed for retrospective studies between January 2005 and December 2018 that assessed postoperative sepsis and SIRS of tubeless mini-PCNL. Studies without data of stone bacterial culture were excluded. The primary outcome was incidence of postoperative sepsis and SIRS. Pooled relative risk or hazard ratio with 95 per cent confidence intervals were calculated for each outcome.
Results: Six retrospective studies with a total 1772 patients were identified for qualitative synthesis. Higher incidence of postoperative SIRS in patients whose bacterial stone culture of tubeless mini-PCNL was positive (Risk ratio(RR) 3.51, 95 per cent c.i. 2.56 to 4.80, P = 0.00001). The incidence of postoperative sepsis was also higher (RR 10.65, 3.89 to 29.17), but the result was without statistically significance (P = 0.41).
Conclusions: Patient with positive stone bacterial culture had a higher rate to develop a postoperative SIRS. Earlier therapeutic antibiotics administration and intensive observation may provide better outcome in such groups of patients.