微创经皮肾镜治疗口服抗凝/抗血小板药物结石患者的安全性及疗效分析  

Efficacy and safety of minimally invasive percutaneous nephrolithotomy in patients on anticoagulant therapy

作　　者：李文标[1] 林婉文 谢文君 湛海伦[1] 周祥福[1] 杨飞[1] Li Wenbiao;Lin Wanwen;Xie Wenjun;Zhan Hailun;Zhou Xiangfu;Yang Fei(Department of Urology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Cardiovascular Medicine,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Operation room,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院岭南医院泌尿外科,广州510530 [2]中山大学附属第三医院岭南医院心血管内科,广州510530 [3]中山大学附属第三医院岭南医院手术室,广州510530

出　　处：《中华腔镜泌尿外科杂志（电子版）》2020年第1期48-51,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金面上项目(81670688)。

摘　　要：目的探讨微创经皮肾镜碎石取石术(MPCNL)治疗口服抗凝药物/抗血小板的上尿路结石患者的疗效及安全性。方法2015年6月至2017年10月,47例接受口服抗凝/抗血小板药物治疗的上尿路结石患者在中山大学附属第三医院岭南医院行MPCNL治疗,围手术期采用低分子肝素替代治疗,术后采用气囊尿管作为肾造瘘管。选取同期行MPCNL治疗的未接受抗凝/抗血小板治疗的、无凝血功能障碍的上尿路结石患者50例进入对照组。比较两组患者间年龄、性别、体质量指数、结石大小等一般情况及手术时间、结石清除率、血红蛋白下降值、住院时间、并发症发生率等的差异。结果两组患者在手术时间、结石清除率、血红蛋白下降值、并发症发生率方面比较差异无统计学意义,抗凝组患者住院时间较非抗凝组时间长,差异具有统计学意义,但是两组患者术后住院天数比较差异无统计学意义。结论围手术期予低分子肝素替代治疗,术后予气囊尿管作为肾造瘘管牵拉压迫止血,口服抗凝/抗血小板药物的上尿路结石患者行MPCNL治疗是安全有效的。Objective To assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy(MPCNL)in treatment of patients receiving anticoagulant therapy.Methods Forty seven patients receiving long term anticoagulant therapy and diagnosis as upper urinary tract calculi underwent MPCNL in the Third Affiliated Hospital of Sun Yat-sen University between June 2015 and October 2017,and defined as Group A.Oral anticoagulant medicine was replaced by low molecular heparin in perioperative period,and balloon catheter was applied as nephrostomy tube postoperatively.Fifty patients diagnosis as upper urinary tract calculi,without blood coagulation disorders and had not received anticoagulant therapy were recruited as control group,and received MPCNL in the meantime,defined as Group B.General condition,operative time,stone free rate,blood loss,hospital stay and complications were compared between the two groups.Result No significant difference was found in operative time,stone free rate,bloom loss and complications between the two groups.Hospital stay in Group A was longer than that in Group B,but no significant difference was found in postoperative hospital stay between the two groups.Conclusion MPCNL is effective and safe in treatment for patients receiving long term anticoagulant therapy,while adequate preparation was made in perioperative period.

关 键 词：微创 经皮肾镜 结石 抗凝 

分 类 号：R699[医药卫生—泌尿科学]