经皮肾镜取石术中及术后出血的相关危险因素分析

Analysis of Risk Factors associated with Bleeding during and after Percutaneous Nephrolithotomy

目的:分析经皮肾镜取石术中及术后出血的相关危险因素。方法:选取珠海市人民医院800例经皮肾镜取石的住院患者作为研究对象,收集入选患者的一般临床资料(性别、年龄、高血压、糖尿病、肝功能不全、肾功能不全、肾积水、泌尿系感染)、结石情况(结石的部位、多少、是否为鹿角型结石)、手术相关情况(通道数目、单通道术中的通道大小、单通道术中的肾盏入路、单通道的体表穿刺位置、是否为分期手术、手术时间),通过单因素分析,发现出血比例与未出血比例的差异具有统计学意义的因素,再将这些因素代入多因素Logistic回归分析,找出导致经皮肾镜取石术中及术后出血的独立危险因素。结果:合并糖尿病的患者术中术后出血的比例明显高于非糖尿病患者(28.57%vs 6.10%),合并肾功能不全患者术中术后出血的比例明显高于肾功能正常者(24.59%vs 6.49%),合并泌尿系感染的患者术中术后出血的比例明显高于非泌尿系感染患者(18.87%vs 5.78%),鹿角型结石患者术中术后出血的比例高于非鹿角型结石患者(16.92%vs 5.56%),单通道取石患者术中术后出血的比例高于多通道取石患者(10.78%vs 1.52%),一期取石患者术中术后出血的比例高于二期取石患者(11.22%vs 2.27%),手术时间≥90 min患者术中术后出血的比例高于手术时间<90 min患者(2.60%vs 10.84%),差异具有统计学意义(P<0.05)。Logistic回归分析显示,合并糖尿病、合并肾功能不全、合并泌尿系感染、鹿角型结石、分期手术为术中术后出血的独立危险因素(P<0.05)。结论:合并糖尿病、合并肾功能不全、合并泌尿系感染、鹿角型结石、分期手术是经皮肾镜取石引发术中术后出血的独立危险因素。

Objective To analyze the related risk factors of bleeding during and after percutaneous nephrolithotomy.Methods Total 800 patients with percutaneous nephrolithotomy hospitalized in Zhuhai Municipal People's Hospital were selected as research objects,whose general clinical data(gender,age,hypertension,diabetes,hepatic insufficiency,renal insufficiency,hydronephrosis and urinary tract infection),stone status(stone location,number of antlers and antler type stone)and surgical related conditions(number of channels,channel size in single-channel surgery,calyceal approach in single-channel surgery,body surface puncture in single channel surgery,staging surgery and operation time)were selected.Univariate analysis and multivariate Logistic regression analysis were used to identify the independent risk factors associated with bleeding during and after percutaneous nephrolithotomy.Results The patients with diabetes mellitus had more bleeding proportion than non-diabetic patients(28.57%vs 6.10%),the patients with renal insufficiency had more bleeding proportion than those with normal renal function(24.59%vs 6.49%),the patients with urinary tract infection had more bleeding proportion than those with non-urinary tract infection(18.87%vs 5.78%),the patients with antlers type stones had more bleeding proportion than those with non-antlers stones(16.92%vs 5.56%),the patients after singlechannel stone surgery had more bleeding proportion than those after multi-channel stone surgery(10.78%vs 1.52%),the patients after one stage surgery had more bleeding proportion than those after two stage surgery(11.22%vs 2.27%),the patients with surgery time≥90 min had more bleeding proportion than those of surgery time<90 min(2.60%vs 10.84%),which were all statistically significant(P<0.05).Logistic regression analysis showed that diabetic patients with renal insufficiency,urinary tract infection,antler type stones and staging were independent risk factors for bleeding(P<0.05).Conclusion It is concluded that combined with diabetes,renal insufficiency,urinary tract infection,antlers stones and staging surgery are independent risk factors for bleeding caused by percutaneous nephrolithotomy.