经皮肾镜碎石术术中及术后出血的影响因素分析  

Risk Factors for Blood Loss during and after Percutaneous Nephrolithotomy

作　　者：张乃文[1] 张祥宇[1] 刘炀[1] 杨绍波[1] 杨春明[1] 刘贤奎[1] 毕建斌[1] 孔垂泽[1] 

机构地区：[1]中国医科大学附属第一医院泌尿外科,沈阳110001

出　　处：《中国医科大学学报》2012年第3期275-277,共3页Journal of China Medical University

摘　　要：目的探讨经皮肾镜碎石术(PCNL)术中及术后出血的影响因素。方法回顾性分析我院2010年1月至2011年4月应用PCNL治疗肾结石的患者142例(151次手术),其中术中及术后输血治疗35例。以可能影响术中及术后出血的患者自身因素(性别、年龄、体质指数、高血压、糖尿病、肝功能不全、肾功能不全、泌尿系感染、肾积水程度及结石大小)及手术相关因素(手术时间、穿刺入径、穿刺次数、通道大小、通道数目、分期手术)为自变量,应用多因素回归分析各因素与是否输血治疗之间的关系,从而找出影响出血的主要因素。结果 151次手术均成功。多因素回归分析显示,患者术前糖尿病史及高血糖状态、肾功能不全、结石大小及手术时间对失血有明显影响(P分别为0.007、0.003、0.000和0.043)。结论患者术前糖尿病史及高血糖状态、肾功能不全、结石过大(尤其是铸型结石)及手术时间过长均能增加患者术中及术后出血风险。术前调整患者血糖及肾功能、缩短手术时间,对结石较大、存在潜在出血风险的患者采取分期手术是减少PCML术中及术后出血的重要措施。Objective To probe factors affecting blood loss during and after percutaneous nephrolithotomy（PCNL）.Methods A retrospectively study was performed to analyze 142 patients with 151 cases of PCNL procedures（35 blood transfusion） admitted in our hospital from January 2010 to April 2011.Various patient related and intra operative factors were assessed by multivariate regression analysis for the correlation with total blood loss.Results The 151 PCNL procedures were all succeeded.Binary logistic multivariate regression analysis showed that diabetes（P =0.007）,renal insufficiency（P =0.003）,stone size（P =0.000） and operative time（P =0.043）significant affected blood loss.Conclusion Diabetes,renal insufficiency,large stone and long operative time are associated with significantly increased blood loss.To control diabetes and renal insufficiency before operation,improve the surgical skills to reduce the operative time and for the large or complex stones cases choosing to operate in stages can help reducing blood loss.

关 键 词：经皮肾镜碎石术 肾结石 出血 多因素分析 

分 类 号：R692.4[医药卫生—泌尿科学]