经皮肾镜碎石取石术治疗上尿路结石并发多重耐药菌感染的研究进展

Research Progress on the Complications of Multidrug-Resistant Organisms Infection after Percutaneous Nephrolithotomy for Upper Urinary Tract Stones

摘要: 经皮肾镜碎石取石术(Percutaneous Nephrolithotomy, PCNL)是目前治疗直径 > 2 cm、鹿角形等复杂性上尿路结石类型的首选微创术式，具有清石率高、创伤可控、术后恢复较快等优势，已广泛应用于临床诊疗中。但术后感染是该术式最常见的并发症之一，其中多重耐药菌(Multidrug-Resistant Organisms, MDRO)感染因耐药谱广、治疗难度大、不良结局风险高，成为制约PCNL疗效进一步提升、威胁患者生命安全的关键问题。近年来，随着抗菌药物的不合理使用及MDRO的流行传播，PCNL术后MDRO感染的发生率呈逐年上升趋势；相关临床研究与基础探索也在不断深入。本文结合近年国内外相关文献，从PCNL治疗上尿路结石并发MDRO感染的临床现状、危险因素、发病机制、治疗策略等方面进行系统综述，为临床优化诊疗方案、降低感染发生率、改善患者预后提供参考依据。

Abstract: Percutaneous Nephrolithotomy (PCNL) is currently the preferred minimally invasive procedure for treating complex upper urinary tract stones with a diameter > 2 cm, such as stag-horn calculi, with advantages including high stone clearance rates, controllable trauma, and relatively quick postoperative recovery, and has been widely applied in clinical practice. However, postoperative infection is one of the most common complications of this procedure, among which infections caused by Multidrug-Resistant Organisms (MDRO) pose a key issue that restricts further improvement of PCNL efficacy and threatens patient safety due to their broad resistance spectrum, treatment difficulties, and high risk of adverse outcomes. In recent years, with the irrational use of antibacterials and the epidemic spread of MDRO, the incidence of MDRO infections after PCNL has shown a yearly increasing trend; related clinical research and basic exploration are also continuously deepening. This article systematically reviews the clinical status, risk factors, pathogenesis, and treatment strategies of MDRO infections complicating PCNL for upper urinary stones based on recent domestic and international literature, providing reference for clinical optimization of treatment plans, reducing infection rates, and improving patient prognosis.