低分子肝素桥接治疗在长期抗栓患者mPCNL围手术期中的安全性和有效性  

Safety and feasibility of bridging with low molecular weight heparin in patients scheduled for percutaneous nephrolithotomy undergoing long-term antithrombotic therapy

作　　者：刘成[1] 黄裕棱 李奎庆[1] 李卓航[1] 许可慰[1] Liu Cheng;Huang Yuleng;Li Kuiqing;Li Zhuohang;Xu Kewei(Department of Urology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《中华泌尿外科杂志》2021年第7期513-517,共5页Chinese Journal of Urology

基　　金：广州市科技计划项目(201803010029)。

摘　　要：目的探讨低分子肝素桥接方案在长期抗栓治疗患者微创经皮肾镜取石术(mPCNL)围手术期应用的安全性和有效性。方法回顾性分析中山大学孙逸仙纪念医院2013年1月至2017年12月50例长期抗栓治疗行mPCNL患者的临床资料。其中,21例血栓高风险患者入院后换用低分子肝素桥接,术前12 h停用低分子肝素,术后48 h内恢复低分子肝素抗凝,拔除肾造瘘管后48 h内恢复术前抗栓治疗,为桥接组。29例血栓中低风险患者术前7 d停用抗栓药物,拔除肾造瘘管后48 h内恢复术前抗栓治疗,为非桥接组。桥接组与非桥接组患者年龄[(59.7±7.1)岁与(52.4±10.4)岁]、性别[男/女:14/7例与19/10例]、体质指数[(24.3±3.9)kg/m^(2)与(24.7±5.1)kg/m^(2)]、S.T.O.N.E.评分[(7.4±1.1)分与(6.9±1.0)分]、结石表面积[314.0(31.4~1130.4)mm^(2)与282.5(64.7~866.0)mm^(2)]、结石累及肾盏[单一肾盏/多个肾盏:6/15例与13/16例]及结石相关手术史[34%(7/21)与24%(7/29)]的差异均无统计学意义(P>0.05)。记录围手术期数据,分析术后结石清除情况以及血红蛋白变化。结果桥接组18例行单通道手术,3例行双通道手术;手术时间80(35~180)min。非桥接组27例行单通道手术,2例行双通道手术;手术时间80(30~160)min。两组单通道比例和手术时间的差异均无统计学意义(P>0.05)。桥接组与非桥接组血红蛋白变化值[18(-2~66)g/L与14(-25~64)g/L]、术后住院时间[(8.6±3.5)d与(7.1±2.3)d]、术后30 d结石清除率[81.0%(17/21)与75.9%(22/29)]的差异均无统计学意义(P>0.05)。两组各有2例术后输血(P=0.74),无行介入栓塞治疗者。桥接组患者围手术期均未发生血栓相关并发症。结论对长期抗栓治疗的患者行mPCNL时,围手术期低分子肝素桥接治疗方案并未增加出血相关风险,且未影响mPCNL的结石清除率。Objective To investigate the safety and efficacy of low molecular weight heparin(LMWH)bridging program in the perioperative period of mini-percutaneous nephrolithotomy(mPCNL)for long-term antithrombotic patients.Methods The clinical data of 50 patients who received long-term antithrombotic therapy with mPCNL in Sun Yat-sen Memorial Hospital from January 2013 to December 2017 were retrospectively analyzed.Perioperative anticoagulation plans were drawn up after discussion with an internist.Patients with high thrombosis risk were bridged with LMWH during the perioperative period.Resumed LMWH anticoagulation within 48 hours after surgery.Patients with low or medium thrombosis risk directly discontinued anticoagulation one week before surgery.Preoperative anticoagulation was resumed within 48 hours after removing the nephrostomy tube in all patients.We analyzed the general information before surgery,data during surgery,postoperative hemoglobin changes and stone-free rate(SRF)of all cases.21 patients were treated with LMWH bridging(bridging group),and 29 patients were directly discontinued with anticoagulant drugs(non-bridging group).There was no statistical difference between the two groups in age[(59.7±7.1)vs.(52.4±10.4)years],gender[(male/female),14/7 vs.19/10],BMI[(24.3±3.9)kg/m^(2) vs.(24.7±5.1)kg/m^(2)],S.T.O.N.E.score(7.4±1.1 vs.6.9±1.0),stone surface area[314.0(31.4-1130.4)mm^(2) vs.282.5(64.7-866.0)mm^(2)],the number of calculi involved in calyces(6/15 vs.13/16)and stone-related surgical history[34%(7/21)vs.24%(7/29)].Results In the bridging group,18 patients(86%)performed single-channel mPCNL,3 patients(14%)underwent dual-channel mPCNL,and the operation time was 80(35-180)min.In the non-bridging group,27 patients(93%)underwent single-channel mPCNL,2 patients(7%)performed dual-channel mPCNL,and the operation time was 80(30-60)min.The mean changes in hemoglobin in the bridging group and the non-bridging group was 18(-2-66)g/L and 14(-25-64)g/L,respectively(P=0.073).The average postoperative hospital stay

关 键 词：肾结石 抗栓治疗 微创经皮肾镜取石术 围手术期 桥接治疗 

分 类 号：R699[医药卫生—泌尿科学]