【摘要】 目的探讨基层医院经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)并发严重出血的危险因素。方法回顾性分析2012年1月—2016年12月我院185例PCNL患者的临床和手术相关资料,其中17例并发严重出血,根据有无严重出血分为出血组(n=17)和无出血组(n=168),通过单因素卡方检验和多因素Logistic回归分析影响PCNL严重出血的因素。结果本组PCNL严重出血发生率为9.19%(17/185)。单因素分析发现,年龄、性别、体质量指数(BMI)、糖尿病、高血压、肾功能不全与PCNL严重出血无明确关联性(P>0.05);肾重度积水、同侧肾结石手术史、结石大小、Guy结石分级、取石通道数目、通道大小、手术时间、术中肾盂穿孔与PCNL严重出血存在关联性,是其影响因素(P<0.05)。多因素Logistic回归分析发现,只有同侧肾结石手术史、Guy结石分级、术中肾盂穿孔是影响PCNL严重出血的独立危险因素。结论存在同侧肾结石手术史、Guy结石分级3~4级或术中肾盂穿孔的PCNL患者围术期发生严重出血的风险较高,临床上应加强对此类患者的防治干预。更多还原

【Abstract】 Objective To investigate the risk factors of severe hemorrhage during and after percutaneous nephrolithotomy(PCNL)in primary hospital.Methods The clinical and surgical data of 185 cases of PCNL patients from January 2012 to December 2016,including 17 cases of severe hemorrhage during and after PCNL,were retrospectively analyzed.According to the presence of severe hemorrhage,the series of patiens were divided into bleeding group(n=17)and non bleeding group(n=168).The single factor chi square test and multiple Logistic regression analysis were used analyse the risk factors of severe hemorrhage during and after PCNL.Results The univariate analysis showed that age,gender,body mass index(BMI),diabetes,hypertension,renal insufficiency does not affect severe hemorrhage during and after PCNL(P>0.05).Giant hydronephrosis,ipsilateral kidney stone surgery,stone size,Guy’s stones grade,the number of channels,channel size,operation time(P=0.029),and intraoperative perforation of the renal pelvis were the influence factors of severe hemorrhage during and after PCNL.Multivariate Logistic regression analysis showed that only the ipsilateral kidney stone surgery,Guy ’s stones grade,and intraoperative perforation of the renal pelvis were independent risk factors of severe hemorrhage during and after PCNL.Conclusion There is a higher risk of perioperative severe bleeding in patients with PCNL of the ipsilateral renal calculi surgery,Guy ’s calculus grade III or IV,and intraoperative perforation of the renal pelvis.we should strengthen the prevention and treatment of these patients.更多还原