经皮肾镜取石术并发出血的危险因素分析

Risk factors of bleeding in percutaneous nephrolithotomy

摘要:

研究经皮肾镜取石术（PCNL）并发出血的危险因素。方法 选取该院2015年2月-2017年2月330例肾结石患者为研究对象，行PCNL术。根据是否并发出血将患者分为出血组与未出血组，收集两组年龄、性别、体质指数（BMI）、合并症、结石类型、结石直径、分期手术、手术时间、穿刺路径、通道数目、肾积水程度和既往手术史等临床与手术资料。结果 330例肾结石患者接受PCNL术治疗，28例患者术后并发出血，出血率为8.5%（28/330）。两组患者年龄、性别、BMI、合并高血压、肝功能异常、分期手术、穿刺路径和既往手术史比较差异无统计学意义（P >0.05），合并糖尿病、鹿角形结石、结石直径≥2 cm、手术时间>60 min、多通道、无或轻度肾积水比例出血组明显高于未出血组（P <0.05）。结论 合并糖尿病、结石类型、结石直径、手术时间、通道数目和肾积度等6个因素对PCNL术并发出血有显著影响。其中结石类型、结石直径、手术时间、通道数目为PCNL术并发出血的独立影响因素。

Abstract:

To study the risk factors of bleeding in percutaneous nephrolithotomy. Methods 330 patients with renal calculi from February 2015 to February 2017 were selected as the research subjects. All the patients were treated by percutaneous nephrolithotomy. According to the occurrence of bleeding, the patients were divided into bleeding group and nonbleeding group. The clinical and surgical data of the two groups such as age, gender, body mass index, complications, type of calculi, diameter of calculi, staging surgery, surgical time, puncture path, number of channels, degree of hydronephrosis and history of surgery were collected. Results Among the 330 patients, there were 28 patients with bleeding after surgery, and the bleeding rate was 8.5% (28/330). There was no significant difference between the bleeding group and the non-bleeding group in age, gender, body mass index, being complicated with hypertension, abnormal liver function, staging surgery, puncture path or history of surgery (P > 0.05). The proportions of patients with diabetes mellitus, patients with staghorn calculi, patients whose calculi were or larger than 2 cm, patients whose surgical time was longer than 60 min, patients with multiple channels and patients without or with mild hydronephrosis in bleeding group were significantly higher than those in nonbleeding group (P < 0.05). Conclusion Diabetes mellitus, type of calculi, diameter of calculi, surgical time, number of channels and degree of hydronephrosis obviously influence the occurrence of bleeding after percutaneous nephrolithotomy. The type of stones, diameter of stones, operative time and number of channels were independent influencing factors of PCNL with bleeding.