肾盂结石患者泌尿软镜应用与住院时间的相关性研究

A Study on the Correlation between the Application of Urological Flexible Endoscopy and Hospital Stay in Patients with Renal Pelvis Stones

摘要: 目的：探讨肾盂结石患者行逆行输尿管软镜碎石术(fURS)后住院时间(LOS) > 48 h的独立危险因素，为快速康复外科(ERAS)路径优化及DRG支付下的日间化管理提供循证截点。方法：回顾性纳入2023年1月~2025年4月珠海市中西医结合医院90例肾盂结石且行fURS患者，按LOS分为≤48 h组与>48 h组各45例。比较两组围手术期指标，采用多因素Logistic回归分析LOS延长的独立影响因素。结果：90例平均LOS (49.33 ± 16.28) h，50%患者 > 48 h。结石最大径、术前尿培养阳性、手术时间及术后6 h CRP进入最终模型：结石最大径每增加1 mm，LOS > 48h风险升高16% (OR = 1.16)；尿培养阳性使风险增加5.1倍(OR = 5.10)；手术时间每延长1 min，风险增加4% (OR = 1.04)；术后6 h CRP每升高1 mg/L，风险增加13% (OR = 1.13)。模型C-index = 0.86，Hosmer-Lemeshow P = 0.60。结论：结石负荷、术前菌尿、手术效率及早期炎症反应是肾盂结石fURS术后LOS延长的四大可干预因素；基于上述指标构建的预测模型可为日间病例筛选与DRG成本控制提供量化工具。

Abstract: Objective: To explore the independent risk factors of hospitalization time (LOS) > 48 h after retrograde ureteroscopic lithotripsy (fURS) for patients with renal pelvis stones, and to provide evidence-based cut-off points for path optimization of rapid rehabilitation surgery (ERAS) and daytime management with DRG payment. Methods: From January 2023 to April 2025, 90 patients with pyelolithiasis who underwent fURS in Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively included, and were divided into two groups according to LOS: ≤ 48 h group and > 48 h group with 45 cases in each group. The perioperative indexes of the two groups were compared, and the independent influencing factors of LOS prolongation were analyzed by multivariate Logistic regression. Results: The average LOS of 90 patients was (49.33 16.28) h, and 50% patients were more than > 48 h hours. The maximum diameter of stone, positive urine culture before operation, operation time and 6 h CRP after operation entered the final model: the risk of LOS > 48 hours increased by 16% for every 1mm increase in the maximum diameter of stone (or = 1.16); Positive urine culture increased the risk by 5.1 times (OR = 5.10). The risk increased by 4% (or = 1.04) for every 1min extension of operation time. Every increase of 1mg/L of 6 h CRP 6 days after operation increased the risk by 13% (OR = 1.13). Model C-index = 0.86, Hosmer-Lemeshow P = 0.60. Conclusion: Stone load, preoperative bacteriuria, operation efficiency and early inflammatory reaction are the four major intervening factors of LOS prolongation after fURS for renal pelvis stones. The prediction model based on the above indicators can provide quantitative tools for daytime case screening and DRG cost control.