【摘要】 目的探讨肾积水程度与经皮肾镜手术术后出血的关系。方法回顾性分析2018年9月～2020年4月在我院行单通道(F20)经皮肾镜碎石取石术病人133例,所有病例均为单纯输尿管上段或肾盂输尿管连接部或肾盂结石,或上述结石合并一处直径<1 cm的下盏结石。根据术前肾积水程度分为无积水或轻度积水组(A组,49例),中度积水组(B组,37例)及重度积水组(C组,47例)。3组病人均采用超声引导下穿刺,建立F20经皮肾通道。统计手术相关参数、出血发生率等。结果所有病人均顺利完成手术。A组术后发生3例明显出血(Clavien2级及以上),其中1例行介入栓塞治疗;C组术后出现明显出血4例,其中1例行介入栓塞治疗;B组无明显出血发生。多因素回归分析显示,中度肾积水及术前血红蛋白水平是术后发生出血相关不良事件的独立影响因素。结论肾脏积水程度可能与经皮肾镜手术后出血风险存在重要关联,其可能的原因是建立通道时不同程度肾积水下精准识别肾盏穹窿部以及扩张通道的难易程度存在差别。更多还原

【Abstract】 Objective To explore the relationship between the degree of hydronephrosis and the bleeding-related complications following percutaneous nephrolithotomy.Methods The data of 133 patients who underwent single-tract(F20) percutaneous nephrolithotomy in our hospital from September 2018 to April 2020 were retrospectively analyzed.All patients with single upper ureter or UPJ or renal pelvis stones,or the above stones accompanied by lower calyx stone less than 1 cm were included.According to the degree of hydronephrosis before operation,patients were divided into no hydronephrosis or mild hydronephrosis group(group A,n=49),moderate hydronephrosis group(group B,n=37) and severe hydronephrosis group(group C,n=47).All operations were performed under ultrasound-guided puncture to establish F20 percutaneous renal access.All patients’ characteristics,surgery-related parameters,and incidence of obvious bleeding-related complications were obtained.Results All operations were successfully completed.There were 3 cases of obvious bleeding complications in the group A,of which 1 case was treated with angioembolization;4 cases of group C had obvious bleeding after operation,of which 1 case underwent angiography and embolization.No obvious bleeding complications occurred in group B.Multivariate regression analysis showed that moderate hydronephrosis and preoperative hemoglobin levels were independent influencing factors for postoperative bleeding-related adverse events.Conclusion The degree of hydronephrosis may have an important effect on the risk of bleeding after percutaneous nephrolithotomy.The possible reason is that the degree of difficulty in accurately identifying the fornix of the calyx and dilation under different degrees of hydronephrosis when establishing the access varied.[Key word]更多还原