男性经皮肾镜取石术后严重出血相关因素分析与介入栓塞疗效评价  

Analysis of factors associated with severe bleeding after percutaneous nephrolithotomy and evaluation of interventional embolization efficacy in male patients

作　　者：国永飞 司同国 张秀军[2] Guo Yongfei;Si Tongguo;Zhang Xiujun(Department of Interventional Therapy,Tianjin Cancer Hospital Airport Hospital,Tianjin 300308,China;Department of Vascular Surgery,Tianjin Nankai Hospital,Tianjin 300102,China)

机构地区：[1]天津市肿瘤医院空港医院微创介入治疗科,天津300308 [2]天津市南开医院血管外科,天津300102

出　　处：《中华内科杂志》2023年第10期1215-1219,共5页Chinese Journal of Internal Medicine

摘　　要：目的:探讨男性经皮肾镜取石术(PCNL)后严重出血的相关因素与介入栓塞疗效初步评价。方法:病例系列研究。分析天津市南开医院2018年1月至2021年10月收治的230例男性上尿路结石患者的临床资料,观察指标包括年龄、高血压、糖尿病、肾功能异常、术前服用抗凝药物史、结石大小、结石类型、穿刺通道数目、手术时间及肾积水程度,描述男性经皮肾镜术后出血的临床特征,并分析PCNL术后严重出血的相关因素。采用 χ2检验进行单因素分析,多因素分析采用logistic回归分析。 结果:单因素分析显示,糖尿病( χ^(2)=4.90, P=0.027)、肾功能异常( χ^(2)=18.32, P<0.001)、术前口服抗凝药病史( χ^(2)=5.10, P=0.024)、出凝血功能异常( χ^(2)=8.22, P=0.004)及穿刺通道数目( χ^(2)=22.08, P<0.001)是影响PCNL术后出血的相关因素。多因素logistic回归分析显示:合并糖尿病( P=0.032)、肾功能异常( P<0.001)及穿刺通道数目( P<0.001)是PCNL术后出血的独立危险因素。其中28例PCNL术后严重出血患者中行介入栓塞治疗25例,技术成功率100.0%,临床成功率为89.3%。 结论:对于肾结石合并糖尿病、肾功能异常及多通道穿刺患者,行PCNL前应当积极给予相关预防措施,从而降低PCNL术后出血风险;对于PCNL术后肾严重出血肾动脉栓塞术是一种安全有效的微创治疗方法。ObjectiveTo explore the factors associated with severe bleeding after percutaneous nephrolithotomy(PCNL)in male patients and evaluate the efficacy of interventional embolization.MethodsA retrospective case series study was conducted at Nankai Hospital of Tianjin,China,from January 2018 to October 2021.The clinical data of 230 male patients with upper urinary tract stones were analyzed.The observation indicators included age,hypertension,diabetes,renal function abnormalities,history of preoperative anticoagulant use,stone size,stone type,number of puncture channels,operation time and degree of hydronephrosis.To describe the clinical characteristics of bleeding after percutaneous nephrolithotomy in men,and analyze the factors associated with severe bleeding after PCNL.Single factor analysis was performed using the Chi-square(χ^(2))test,and multivariate analysis was performed using logistic regression analysis.ResultsUnivariate analysis showed that diabetes mellitus(χ^(2)=4.90,P=0.027),abnormal renal function(χ^(2)=18.32,P<0.001),history of preoperative oral anticoagulants(χ^(2)=5.10,P=0.024),abnormal bleeding and coagulation function(χ^(2)=8.22,P=0.004)and the number of puncture channels(χ^(2)=22.08,P<0.001)were the related factors affecting bleeding after PCNL.Multivariate logistic regression analysis showed that diabetes mellitus(P=0.032),abnormal renal function(P<0.001),and the number of puncture channels(P<0.001)were the independent risk factors of bleeding after PCNL.Of the 28 patients with bleeding after PCNL,25 were treated with interventional embolization,with a technical success rate of 100.0%and a clinical success rate of 89.3%.ConclusionsFor patients with renal calculi and comorbid diabetes,renal function abnormalities,and multiple punctures,relevant preventive measures should be actively administered before PCNL to reduce the risk of postoperative bleeding.For patients with severe bleeding of the kidney after PCNL,TAE is a safe and effective minimally invasive treatment method.

关 键 词：尿路结石 出血 栓塞 治疗性 经皮肾镜取石术 

分 类 号：R699.2[医药卫生—泌尿科学]