输尿管软镜碎石术在免疫功能损伤患者中应用的安全性与有效性分析

Safety and efficacy of retrograde intrarenal surgery in patients with compromised immune function

摘要

目的 比较输尿管软镜碎石术在免疫功能损伤群体和非损伤群体中应用的安全性和有效性。方法 本研究为单中心回顾性病例对照研究，纳入2014年1月-2024年12月在我院接受 RIRS治疗的免疫功能损伤患者。对照组为同期接受单侧 RIRS且无免疫功能损伤的患者。通过倾向性评分匹配（PSM）进行1∶3匹配。比较两组的人口统计数据、手术时间、结石清除率、并发症率等指标。结果 共纳入404名患者，其中101名为免疫损伤患者，303名为对照组。两组在年龄、性别、BMI和侧别方面无显著差异（P＞0.05）。免疫损伤组术前尿培养阳性比例较高，且有更高比例的 ESBL 多重耐药细菌感染（P＜0.05）。手术时间两组无显著差异（P＞0.05），但免疫损伤组总体并发症率和主要并发症率较高（P＜0.05），术后尿路感染比例也更高（P＜0.05）。两组术前血红蛋白水平相似，但术后病例组显著低于对照组，输血率也存在显著差异（均P＜0.05）。结论 尽管免疫功能受损的患者群体在 RIRS后有更高的并发症风险，但经充分术前准备后 RIRS在这类患者中仍是一种安全有效的治疗方法。本研究提供了 RIRS在免疫功能受损患者中的临床实践数据，为未来的前瞻性多中心合作研究提供了基础。

Abstract

Objective To compare the safety and efficacy of retrograde intrarenal surgery（RIRS）between patients with compromised immune function and healthy controls. Methods This single-center retrospective case-control study included patients with compromised immune function who underwent RIRS at our hospital during Jan.2014 and Dec.2024.The control group consisted of patients without immune compromise who underwent unilateral RIRS during the same period.Propensity score matching（PSM）was performed at a 1∶3 ratio.Demographic data，operation time，stone-free rate，complication rate，and other indicators were compared between the two groups. Results A total of 404 subjects were included， including 101 immune-compromised patients and 303 healthy controls.There were no significant differences between the two groups in terms of age，gender，body mass index（BMI），and laterality（P＞0.05）.The immune-compromised group had a higher proportion of positive preoperative urine culture and a higher incidence of ESBL-producing multidrug-resistant bacterial infections（P＜0.05）.While there was no significant difference in operation time between the two groups（P＞0.05），the immune-compromised group exhibited higher overall and major complication rates（P＜0.05），as well as a higher incidence of postoperative urinary tract infections（P＜0.05）.Preoperative hemoglobin level was similar between the groups；however，postoperative hemoglobin level was significantly lower in the immune-compromised group，and the transfusion rate also showed a significant difference（both P＜0.05）. Conclusion Although patients with compromised immune function face a higher risk of complications following RIRS，the procedure remains a safe and effective treatment option when adequate preoperative preparation is undertaken.This study provides clinical data on RIRS in immune-compromised patients， laying the foundation for future prospective multicenter collaborative research.

关键词

输尿管软镜碎石术 / 免疫功能损伤 / 倾向性评分匹配 / 安全性 / 有效性

Key words

retrograde intrarenal surgery / immune function compromise / propensity score matching / safety / efficacy

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