开放性肾部分切除术后出血的危险因素分析及临床处理

Risk factors and clinical management of hemorrhage after open partial nephrectomy

目的 总结开放性肾部分切除手术后出血的危险因素及临床处理方法. 方法 回顾性分析2008年5月至2011年10月362例行开放性肾部分切除术患者的资料,分析患者年龄、性别、体质指数、ASA评分、有无临床症状、高血压、糖尿病、冠心病/充血性心力衰竭、肿瘤良性和多发性及术前解剖影像分类系统（preoperative aspects and dimensions used for anatomical classification,PADUA）评分与术后出血的关系,并分析术后出血的临床处理方法. 结果 362例术后发生严重出血15例（4.1％）.Logistic多因素回归分析结果显示,PADUA评分（P＜0.001）和多发肿瘤（P=0.004）是开放性保留肾单位手术出血发生的独立危险因素.15例患者中,保守治疗止血11例,行高选择性肾动脉栓塞4例,均顺利出院. 结论 高PADUA评分和多发肿瘤是开放性肾部分切除手术出血的独立危险因素.高选择性肾动脉栓塞是肾部分切除术后出血安全有效的处理手段.

Objective To identify the risk factors for hemorrhage after open partial nephrectomy （OPN） for renal tumor, and to discuss the clinical management. Methods From May 2008 to October 2011, 362 consecutive patients who underwent OPN in Renji Hospital were analyzed in this study. Sex, age, body mass index, ASA score, hypertension, diabetes mellitus, coronary artery disease/congestive heart fail- ure, multifocality, malignant vs benign pathology and preoperative aspects and dimensions used for anatomi- cal classification （PADUA） score were tested and significant variables entered in a multivariate model asso- ciated with hemorrhagic complications （blood loss requiring blood transfusion）. The clinical management of hemorrhage after OPN was reviewed. Results Fifteen patients with bleeding received blood transfusion in the 362 cases. On multivariate analysis, PADUA score （P〈0.001） and muhifocal tumors （P= 0.004） were independent risk factors associated with hemorrhagic complications. Among 15 bleeding patients, 11 received conservative therapy ; other 4 needed superselective percutaneous transarterial embolization （ TAE）. Bleeding was finally controlled in all the 15 patients. Conclusions High PADUA score and multifocal tumors could be identified as risk factors for hemorrhage after OPN. The management was relying on TAE as an effective and safe treatment for bleeding after OPN.