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目的:回顾分析经皮肾镜取石术(PCNL)术中及术后出血的危险因素。方法:回顾分析2009年6月~2013年6月广西医科大学第一附属医院行PCNL治疗上尿路结石的740例(923次)患者资料,用logistic回归分析寻找影响出血的主要因素。结果:740例(923次手术)患者均成功建立通道并碎石。单通道取石674例,多通道取石66例,其中2通道39例,3通道17例,4通道10例。平均手术时间(109.3±48.2)min。术中平均出血量(76.9±108.8)ml,单通道(64.3±92.7)ml,多通道(205.5±164.8)ml。术中、术后出血≥400ml者共42例,1例转开放行肾破裂修补术,12例予以选择性肾动脉栓塞治疗并一次成功,29例予以保守治疗成功。多元回归分析显示糖尿病(P=0.031)、肾功能不全(P=0.001)、泌尿系感染(P=0.002)、鹿角形结石(P=0.000)、通道的数目(P=0.002)、分期手术(P=0.006)及手术时间(P=0.000)7个因素对出血有显著影响。结论:合并糖尿病、肾功能不全、泌尿系感染以及鹿角形结石、多通道取石、手术时间长对出血有显著影响,分期手术可减少出血。
Objective: To retrospectively analyze the risk factors of percutaneous nephrolithotomy (PCNL) intraoperative and postoperative bleeding. Methods: The data of 740 patients (923 times) treated with PCNL in the First Affiliated Hospital of Guangxi Medical University from June 2009 to June 2013 were retrospectively analyzed. Logistic regression analysis was used to find out the main factors influencing bleeding. Results: All the 740 patients (923 surgeries) successfully established channels and gravel. Single-channel stone 674 cases, 66 cases of multi-channel stone, of which 39 cases of 2 channels, 3 channels in 17 cases, 4 channels in 10 cases. The average operation time (109.3 ± 48.2) min. Mean intraoperative blood loss (76.9 ± 108.8) ml, single-channel (64.3 ± 92.7) ml, multi-channel (205.5 ± 164.8) ml. During operation, 42 cases had hemorrhage≥400ml after operation, one case underwent renal rupture repair after conversion. 12 cases were treated with selective renal artery embolization and were successful, and 29 cases were treated conservatively. Multivariate regression analysis showed that diabetes (P = 0.031), renal insufficiency (P = 0.001), urinary tract infection (P = 0.002), antler calculi (P = 0.000), number of channels (P = 0.002) P = 0.006) and operation time (P = 0.000) 7 factors have a significant impact on bleeding. Conclusion: Combined with diabetes mellitus, renal insufficiency, urinary tract infection, staghorn calculi, multi-channel lithotripsy and long operation time have significant effects on bleeding, and staging can reduce bleeding.