经皮肾镜碎石取石术后严重出血的危险因素分析  

Risk factors of severe bleeding after percutaneous nephrolithotomy

作　　者：付光庆[1,2] FU Guangqing(Department of Urology,the Fourth People's Hospital of Zigong,Zigong 643000,China;Institute of Precision Medicine,Zigong Institute of Medical Big Data and Artificial Intelligence,Zigong 643000,China)

机构地区：[1]自贡市第四人民医院泌尿外科,四川自贡643000 [2]自贡市医学大数据与人工智能研究院精准医学研究所,四川自贡643000

出　　处：《当代医药论丛》2022年第21期3-7,共5页

基　　金：自贡市重点科技计划项目(编号:2020ZC14)。

摘　　要：目的:对接受介入栓塞术的患者进行回顾,明确可预测经皮肾镜碎石取石术(PCNL)后严重出血的危险因素。方法:回顾性分析2011年至2021年在自贡市第四人民医院接受PCNL的583例患者的临床资料。其中术后发生严重出血需行介入栓塞术的患者有9例,对其术前情况、术中表现和术后因素与PCNL后无出血的患者进行比较,总结引起PCNL后严重出血的危险因素。结果:在583例患者中,有3例(0.51%)患者术后发生严重出血需行介入栓塞术以控制出血。术前基本情况包括有同侧肾脏手术史(P=0.0025)和复杂性结石(P=0.006)是引发术后出血的重要危险因素,而术中的重要危险因素是肾盂系统损伤(P=0.0005)和多通道损伤(P=0.022)。经血管造影提示2例患者有动静脉瘘,7例患者有假性动脉瘤,所有患者均成功进行了超选择性介入栓塞术。结论:有同侧肾脏手术史、复杂性结石、肾盂系统损伤和多通道损伤是预测PCNL后严重出血的危险因素,对于PCNL后严重出血且经保守治疗无效的患者,应早期行血管造影和介入栓塞术。Objective:To identify risk factors that predict severe bleeding after percutaneous nephrolithotomy(PCNL)by reviewing patients who underwent interventional embolization.Methods:The clinical data of 583 patients who underwent PCNL in Zigong Fourth People’s Hospital from 2011 to 2021 were retrospectively analyzed.Among them,there were 9 patients who needed interventional embolization for severe bleeding after PCNL.The preoperative conditions,intraoperative manifestations and postoperative factors were compared with those of patients without bleeding after PCNL,and the risk factors of severe bleeding after PCNL were summarized.Results:Among 583 patients,3 patients(0.51%)had severe bleeding after operation and needed interventional embolization to control bleeding.Preoperative basic conditions including ipsilateral renal operation history(P=0.0025)and complex stones(P=0.006)were the important risk factors for postoperative bleeding,while the important risk factors during operation were renal pelvis system injury(P=0.0005)and multichannel injury(P=0.022).Angiography showed arteriovenous fistulas in 2 patients and pseudoaneurysms in 7 patients.All patients underwent successful super-selective interventional embolization.Conclusion:The history of ipiliateral renal surgery,complicated calculi,renal pelvic system injury and multichannel injury are risk factors for predicting severe bleeding after PCNL.For patients with severe bleeding after PCNL and no response to conservative treatment,angiography and interventional embolization should be performed early.

关 键 词：介入栓塞术 经皮肾镜碎石取石术 术后严重出血 危险因素 肾结石 

分 类 号：R692.4[医药卫生—泌尿科学]