经皮肾镜碎石术出血的影响因素分析

Analysis of influencing factors of hemorrhage caused by percutaneous nephrolithotripsy

目的探讨引起经皮肾镜碎石术(PCNL)出血的影响因素,做好预防措施,提高手术安全有效性。方法选取2015年1月—2019年9月在我院行PCNL的上尿路结石患者430例,分别从患者的一般情况包括年龄、性别、糖尿病病史、高血压病病史、泌尿系感染、肾积水程度、肾功能不全、孤立肾;患者的结石情况包括结石形态、结石多少、结石大小、结石位置;手术相关情况包括穿刺通道的大小、穿刺通道的路径、分期手术、手术时间,进行单因素χ2检验,再对有意义的指标进行多因素Logistic回归分析。结果χ2检验发现糖尿病病史、泌尿系感染、鹿角形结石、结石大小、分期手术、手术时间具有统计学意义(P<0.05)。多因素Logistic回归分析糖尿病病史、泌尿系感染、鹿角形结石、分期手术、手术时间>90 min与术中及术后出血有关。结论糖尿病病史、泌尿系感染、鹿角形结石、手术时间>90 min是增加出血的风险因素,分期手术可减少出血的发生。

Objective To investigate the influencing factors of percutaneous nephrolithotripsy(PCNL)hemorrhage and take preventive measures for improving the safety and effectiveness of the surgery.Methods A total of 430 patients with upper urinary stones who underwent PCNL in our hospital from January 2015 to September 2019 were selected.Single-factor chi-square test was performed on the general conditions(including age,gender,history of diabetes,history of hypertension,urinary tract infection,degree of hydronephrosis,renal insufficiency and isolated kidney),stone conditions(including the morphology of stones,the number of stones,the size of stones and the location of stones)and operative conditions(including the size of the puncture channel,the path of the puncture channel,staging operation and operation duration)of all the patients.Then the multivariate Logistic regression analysis was performed on significant indicators.Results Chi-square test showed that the history of diabetes,urinary infection,antler-shaped stone,stone size,staging operation and operation duration were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that history of diabetes mellitus,urinary tract infection,antler-shaped stone,staging operation and operation duration>90 minutes were associated with intraoperative and postoperative hemorrhage.Conclusion Having a history of diabetes,urinary tract infection,antler-shaped stone,and operation duration>90 minutes are risk factors for hemorrhage.Staging operation can reduce the incidence of hemorrhage.