【摘要】 目的探讨在超声引导下"经肾盏穹窿-盏颈轴线两步穿刺法"建立经皮肾通道碎石取石术中、术后出血的原因。方法回顾性分析2013年6月至2016年6月武汉大学人民医院行经皮肾镜碎石取石术(PCNL)治疗上尿路结石的1 555例患者的临床资料。通过对年龄、性别、体质量指数、结石大小、结石类型、肾脏集合系统结构、肾脏积水程度、是否合并高血压及糖尿病,通道大小、通道数量、碎石工具等相关因素进行单变量及Logistic回归分析,探讨PCNL出血的可能因素。结果 1 555例手术均由同一名主刀医师顺利完成,术中或术后进行输血治疗的患者有56例,输血率为3.6%。其中11例出血的患者因保守治疗效果不佳,进一步行超选择性栓塞治疗。在单变量及Logistic回归分析中发现结石类型(P<0.001,OR=-1.963)、结石大小(P=0.009,OR=1.687)、通道数量(P<0.001,OR=2.121)、肾脏集合系统结构(P<0.001,OR=2.128)以及合并糖尿病(P<0.001,OR=1.593)是影响手术出血主要因素。结论经"肾盏穹窿-盏颈轴线两步穿刺法"建立PCNL通道是一项安全,有效的技术。术中、术后出血与合并有糖尿病史、肾脏集合系统结构异常、结石负荷过大(尤其鹿角形结石)及术中建立多通道等因素有关。更多还原

【Abstract】 Objective To investigate the risk factors affecting bleeding during and after percutaneous nephrolithotomy(PCNL) under solo ultrasound-guided access with axis positioning of two steps punctures. Methods The clinical data of 1 555 procedures to cure calculus of upper urinary tract in Renmin Hospital of Wuhan University during June 2013 to June 2016 were retrospectively reviewed. The following factors were analyzed, including age, sex, BMI, stone type, diabetes status, hypertension status, stone size, the degree of hydronephrosis, the structure of the collecting system, and the operative factors including size of passage, number of passage, the devices for disintegrating stones. The univariate analysis and Logistic analysis were used to explore possible factors which may cause bleeding during and after PCNL. Results All the 1555 procedures were successfully completed by the same surgeon. A total of 56 patients received blood transfusion and the rate of the blood transfusion was 3.6%. Furthermore, 11 patients among those received selective arterial embolisation. According to univariate and logistic analysis, the factors including stone type(P<0.001, OR=-1.963), stone size(P=0.009, OR=1.687), number of passage(P<0.001, OR=2.121), the structure of the collecting system(P<0.001, OR=2.128), diabetes status(P<0.001, OR=1.593) were the main factors affecting blood loss. Conclusion PCNL under solo ultrasound-guided access with axis positioning of two steps puncturs is safe and effective. The factors including huge stone especially for staghorn stones, diabetes mellitus, multiple passages and unusual structure of the collecting system were closely related with the bleeding during and after PCNL.更多还原