经皮肾镜碎石取石术出血的影响因素探究及处理方法

目的经皮肾镜碎石取石术（PCNL）是现阶段治疗上尿路结石较为有效的一种手术方式，而出血则是PCNL手术的最常见并发症。本文探讨PCNL出血的相关影响因素，并对PCNL手术出血患者的处理方法进行总结。方法回顾性分析2011年1月至2015年12B接受PCNL的1610例上尿路结石患者的临床资料。将其按照是否发生术中或术后大出血分为出血组（43例）和未出血组（1567例），比较两组间性别、泌尿道感染、合并高血压、肾积水程度、结石位置等是否存在差异，分析术中或术后是否大出血的影响因素及其作用大小．并总结出血组43例患者的处理方法及结果。结果出血组与未出血组的性别、肾积水程度、术中出血量差异有统计学意义（P〈0.05）。手术是否出血受术中出血量（OR=1．003）、肾积水程度（OR=0．393）、性别影响（OR=0．249），影响作用依次减小。结论PCNL是否并发大出血与术中出血量、肾积水程度、性别有关，术中出血量大、肾无积水或轻度积水、男性患者更有并发大出血的倾向。介入栓塞止血及开放止血是处理PCNL手术并发大出血的有效方法。

Objective Percutaneous nephrolithotomy （ PCNL ） is a efficient surgical option for upper urinary calculi at this stage, and bleeding is the most common complication of PCNL. Our study identified the risk factors predicting severe hemorrhage in PCNL, and summarized the treatment of severe hemorhage in PCNL. Methods A retrospective study was made on 1610 cases with upper urinary tract stone that had undergone PCNL in our hospital between January 2011 and December 2015. We divided the cases into two groups according to whether severe hemorrhage.Data on patients who experienced severe hemorrhage （ 43 cases ） were compared with other patients （ 1567 cases ） used statistical analysis, and we made a summary of the treatment and results of 43 cases experienced severe hemorhage in PCNL. Results The differences of the blood loss in operation （ OR=1.003 ） , the level of hydronephrosis （ OR=0.393 ） and gender （ OR=0.249 ） were significant （ P〈0.05 ） , and their affecting degree minished in order. Conclusion The blood loss in operation, the level of hydronephrosis and gender are risk factors for severe hemorrhage. The patients with more blood loss in operation, with lighter degree of hydronephrosis and male patients are more likely to suffer severe renal bleeding.Selective renal artery embolization therapy and open hemostasis are effective methods to deal with massive hemorrhage after PCNL operation.