围手术期停用抗凝药物对于输尿管软镜治疗肾结石疗效及安全性研究

Safety and efficacy of flexible ureterorenoscopy for renal calculi in oral anticoagulated cases

目的:探讨围手术期间是否停用抗凝药物对于输尿管软镜治疗肾结石疗效及安全性的影响。方法:回顾性分析上海交通大学医学院附属第九人民医院2013年7月-2018年7月收治的167例肾结石患者资料,根据患者的围手术期抗凝药(华法林、波立维或阿司匹林)服用情况分为两组,其中A组实验组86例,术前根据原方案持续口服抗凝药物;B组对照组81例,术前1周停用抗凝药物。对比两组患者的手术时间、术中术后并发症、结石清除率、血尿等情况。结果:两组患者的年龄、结石大小、结石位置、结石成分和麻醉评分均无明显差异。A组的手术所需时间更长(50.0 vs.44.0min,P=0.002),但术中视野清晰度可保证手术顺利完成。两组均无患者需要输血,两组患者围手术期均未出现严重出血。术后1个月的结石清除率在华法林、波立维或阿司匹林各亚组之间(87.0%、83.3%vs.94.9%,P=0.984)及A、B两组之间均差异无统计学意义(89.5%vs.85.2%,P=0.826)。结论:综合考虑手术疗效及围手术期风险,肾结石患者在进行输尿管软镜钬激光碎石术前无需暂停使用抗凝药物。

Objective:To investigate the efficacy and safety in patients undergoing flexible ureterorenoscopy for renal calculi with or without anticoagulation during perioperative period.Methods:A retrospective analysis was made of 167 patients with renal calculi admitted to the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University from July 2013 to July 2018.According to the perioperative use of anticoagulants(warfarin,polivix or aspirin),the patients were divided into two groups,86 in group A and 81 in group B.Different from group A,the patients in group B discontinued the anticoagulation therapy one week before operation.The two groups were compared with the operative time,the stone-free rate,hematuria and intraoperative and postoperative complications.Results:There were no significant differences in age,size,location,composition and ASA score between the two groups.The operation time of group A was longer(50.0 vs.44.0 min,P=0.002).No procedure had to be terminated in the anticoagulation group due to poor visibility from bleeding.No need for blood transfusion in both groups,and no severe bleeding occurred in both groups during perioperative period.There was no significant difference in stone clearance within warfarin,polivix or aspirin subgroups(87.0%、83.3%vs.94.9%,P=0.984),also between Group A and Group B(89.5%vs.85.2%,P=0.826).Conclusions:Considering the operative effect and perioperative risk,there was no need to suspend anticoagulants before flexible ureterorenoscopy.