【摘要】 目的探讨影响经皮肾镜取石术出血量的可能相关因素,进而选取更好的方法以减少手术出血量。方法我院2008至2011年159例住院患者共进行178次经皮肾碎石取石手术,其出血量通过血红蛋白及红细胞压积的下降幅度来评估,分析其影响出血量的可能因素并统计分析。结果总的结石清除率为85.4%。平均手术时间89.6±49.2min,平均红细胞压积损失量为0.085±0.049,平均血红蛋白损失量为19.3±12.1g/L。多因素逐步回归分析示肾实质厚度、肾积水程度及结石表面积、操作并发症、分期手术、手术时间、操作通道数目对术中失血量的影响有统计学意义(P<0.05)。结论肾实质厚度、肾积水程度、结石大小、术中操作并发症、手术时间、扩张通道数目是微创经皮肾镜取石术术中失血量的主要影响因素。同时糖尿病影响出血。尽量避免术中操作并发症、减少手术时间、对于大体积结石或现操作并发症的患者选择分期手术有助于减少失血量。更多还原

【Abstract】 Objectives To identify variables that might influence hemorrhage during percutaneous nephrolithotomy (PCNL) and search for certain procedural modifications in attempt to reduce bleeding. Methods The data of 159 patients (178 PCNL procedures) from January 2008 to December 2011 were retrospectively analyzed. Hemorrhage was estimated by the postoperative decrease in hematocrit and hemoglobin factored by the quantity of any blood transfusion. Various preoperative and operative factors were assessed for their association with blood loss using univariate, forward multivariate regression and correlation analysis. Results The overall stone-free rate was 85.4%. The mean operate time was 89.6±49.2 min. The average hematocrit decrease was 8.5%±4.9% (range 0.3 to 24.7) and the average hemoglobin drop was 19.3±12.1g/L. Forward multivariate regression analysis identified following significant variables that influenced PCNL-related hemorrhage: stone type (P=0.003), number of tracts (P=0.010), diabetes (P=0.05), the degree of hydronephrosis (P=0.030) and stone surface area (P=0.049). A statistically significant difference was found in relation to the occurrence of hemorrhage between patients with caliceal stones and staghorn stones (P=0.008), single tracts and multiple tracts (P=0.038), patients with small stones (1000 mm2 or smaller) and large stones (greater than 1000 mm2; P=0.018) on univariate analysis. Factors such as age, hypertension, renal insufficiency and urinary infection did not have any effect on the blood loss. Conclusions Thickening renal parenchyma, hydronephrosis and large stone burden were associated with increased renal hemorrhage during PCNL on multivariate analysis. Multiple-tract procedures, prolonged operative time, and the occurrence of intraoperative complications are associated with significantly increased blood loss. Diabetes is also associated with hemorrhage. On the basis of this evidence, maneuvers that may reduce blood loss and transfusion rate include reducing the operative time and staging the procedure in case of a large stone burden or intraoperative complications.更多还原