输尿管镜碎石术后继发肾包膜下血肿的相关风险因素

Risk factors of subcapsular renal hematoma after ureteroscopy lithotripsy

目的分析输尿管镜碎石术后继发肾包膜下血肿的相关风险因素,以期降低其发生率。方法回顾性分析2010年1月至2015年12月期间在我院行输尿管镜钬激光碎石术的763例患者的临床资料。依据术后有无继发肾包膜下血肿分为血肿组和无血肿组,应用t检验、Fishers精确检验及Logistic回归分析确定输尿管镜碎石术后继发肾包膜下血肿的独立危险因素。结果18例(2.4%)患者术后出现肾包膜下血肿,其中男13例,女5例。单因素分析结果显示血肿组与无血肿组比较年龄(P=0.042)、结石大小(P=0.044)、是否合并尿路感染(UTI)(P=0.01)、手术时间(P=0.028)及液体灌注速度(P=0.036)等均存在明显统计学差异,而性别(P=0.259)、结石侧别(P=0.711)、肾积水(P=0.119)、结石位置(P=0.16)、术前是否留置支架管(P=0.621)则无明显统计学差异。对单因素分析存在统计学差异的变量因素进行Logistic回归分析,结果表明结石大小(OR=2.44,P=0.032)、是否合并尿路感染(OR=1.95,P=0.025)、手术时间(OR=2.51,P=0.002)及液体灌注速度(OR=3.03,P=0.004)是输尿管镜碎石术后继发肾包膜下血肿的独立危险因素。结论输尿管镜碎石术后存在继发肾包膜下血肿的风险,其中结石大小、是否合并尿路感染、手术时间及液体灌注速度是其独立危险因素,应引起泌尿外科医生的重视。

ObjectiveTo analyze the incidence and risk factors of subcapsular renal hematoma （SRH） after ureteroscopy lithotripsy （URL）, in order to reduce the incidence of SRH.MethodsThe clinical data of 763 patients who underwent URL during Jan. 2010 and Dec. 2015 were retrospectively reviewed.The demographic information, stone characteristics, and treatment parameters were collected and analyzed.t-test,Fisher exact test and multivariate Logistic regression analysis were used to identify the risk factors of SRH. ResultsOf the 763 patients, 18（2.4%） had SRH after URL, including 13 male and 5 female.Age, stone size, urinary tract infection （UTI）, operation time, irrigation flow rate had significant impact on SRH after URL according to univariate analysis.There were no statistically significant differences in sex, stone side, stone location and stent placed before operation between patients with and without SRH.The results of multivariate logistic regression analysis showed stone size, UTI, operation time, and irrigation flow rate were the independent risk factors of SRH after URL.ConclusionStone size, UTI, operation time, and irrigation flow rate were the independent risk factors of SRH after URL.