微创经皮肾镜取石术出血影响因素的临床分析  

Analysis of factors for bleeding during minimally invasive percutaneous nephrolithotomy

作　　者：钟辛[1] 徐瑞权[1] 邹晓峰[1] 袁源湖[1] 肖日海[1] 张国玺[1] 杨军[1] 薛义军[1] 伍耿青[1] 王晓宁[1] 刘佛林[1] 龙大治[1] 吴玉婷[1] 徐辉[1] 刘敏[1] 谢昆林 

机构地区：[1]赣南医学院第一附属医院泌尿外科江西省尿路结石现代治疗中心,江西赣州341000

出　　处：《微创泌尿外科杂志》2014年第4期-,共4页Journal of Minimally Invasive Urology

基　　金：江西省"赣鄱英才555工程"领军人才培养计划项目;江西省科技厅科技支撑计划重点项目(2010BSA14500);江西省科技厅科技支撑计划项目(20132BBG70089);江西省卫生厅重大科技计划项目(20084010)

摘　　要：目的:探讨影响微创经皮肾镜取石术(MPCNL)出血的相关因素,提高MPCNL的安全性.方法:回顾性分析2011年9月～2012年5月接受MPCNL治疗的360例上尿路结石患者临床资料.分析患者因素(年龄、身体质量指数、高血压、糖尿病、肝功能不全、肾功能不全、泌尿系感染、肾脏既往手术史、肾实质厚度、肾积水程度及结石大小)和手术相关因素(皮肾通道入路、扩张通道大小、通道数目、手术时间、术中操作并发症、手术分期)对术中出血的影响.结果:360例手术均成功.多元线性回归分析显示,结石大小、肾积水程度、肾实质厚度、糖尿病、手术时间、通道数目、分期手术、操作并发症等对出血有明显影响(P值分别为0.031、0.024、0.000、0.038、0.035、0.026、0.000、0.000).结论:结石大小、肾积水程度、肾实质厚度、糖尿病、手术时间、通道数目、分期手术、操作并发症是影响MPCNL术中出血的主要因素.避免术中操作并发症,减少通道数目、缩短手术时间及选择分期手术可减少MPCNL手术出血.Objective:To investigate the factors for bleeding during minimally invasive percutaneous nephrolithotomy(MPCNL).Methods:The clinical data of 360 patients who underwent MPCNL by a single surgeon from September 2011 to May 2012 were analyzed retrospectively.The clinical factors for bleeding included age,body mass index(BMI),hypertension,diabetes,hepatic insufficiency,renal insufficiency,urinary infection,history of open surgery in kidney,thickness of the renal parenchyma,hydronephrosis and stone size.The surgery-related factors for bleeding included the approach to suspected renal calix,size and number of tract,operative time,operation complications,and operation staging.The relation between the factors and bleeding during MPCNL was analyzed.Results:All the procedures were successfully completed.Multiple linear regression analysis showed that stone size(P =0.031),hydronephrosis(P=0.024),thickness of renal parenchyma(P=0.000),diabetes(P=0.038),operative time(P=0.035),number of tract(P=0.026),operation staging(P=0.000),and operation complications(P=0.000)significant affected blood loss.Conclusions:The size of stone,hydronephrosis,thickness of renal parenchyma,diabetes,operative time,number of tract,operation staging,and operation complications are the main risk factors for bleeding in MPCNL.Avoiding operation complications,reducing tracts and operative time,and selectingstaging operation may reduce the risk of bleeding during MPCNL.

关 键 词：微创经皮肾镜取石术 出血 并发症 多元线性回归分析 

分 类 号：R692.4[医药卫生—泌尿科学]