经皮肾镜取石术术中及术后出血的危险因素分析
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摘要
目的:探讨影响经皮肾镜取石术(PCNL)术中及术后出血的危险因素。方法:回顾分析莆田市第一医院2010年6月至2016年12月行经皮肾镜取石术治疗上尿路结石的582例患者资料,用多元回归分析寻找影响出血的主要因素。结果:582例均成功手术,采用F16通道81例,F24通道501例,平均手术时间(81.2±29.5)min。术中、术后出血≥400ml者共32例,1例术后选择性肾动脉栓塞治疗无效行肾破裂切除术,9例予以选择性肾动脉栓塞治疗并一次成功,22例予以保守治疗成功。多因素回归分析表明,泌尿系感染(OR=1.693)、肾功能不全(OR=2.527)、糖尿病(OR=2.265)、鹿角形结石(OR=3.332)、手术时间(OR=1.982)及分期手术(OR=0.594)增加出血的风险。结论:合并泌尿系感染、肾功能不全、糖尿病、鹿角形结石及手术时间长显著增加经皮肾镜取石术出血风险,分期手术可减少出血可能。
引文
[1]廖尚范,卢东明,伊岱旭.经皮肾镜取石术后迟发性严重出血特点及选择性肾动脉栓塞时机[J].甘肃医药,2016,35(9):694-697.
[2]章俊,王阳赟,王曦龙,等.经皮肾镜碎石术中及术后出血需输血治疗的风险因素分析[J].现代泌尿外科杂志,2014,19(9):580-583.
[3]Nouralizadeh A,Ziaee S A M,Sharifi S H H,et al.Delayed postpercutaneous nephrolithotomy hemorrhage:Prevalence,predictive factors and management[J].Scandinavian Journal of Urology,2014,48(1):110.
[4]梁欣炜.经皮肾镜取石法手术治疗肾结石效果及出血因素分析[J].黑龙江医学,2016,40(6):507-508.
[5]Akman T,Binbay M,Sari E,et al.Factors affecting bleeding during percutaneous nephrolithotomy:single surgeon experience[J].Journal of Endourology,2011,25(2):327-333.
[6]Yamaguchi A,Skolarikos A,Buchholz N P,et al.Operating times and bleeding complications in percutaneous nephrolithotomy:a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study[J].Journal of Endourology,2011,25(6):933-939.
[7]邢兆辉.联合微通道及标准单通道PCNL治疗糖尿病鹿角形肾结石疗效分析[J].糖尿病新世界,2016,19(11):52-53.
[8]El-Nahas A,Shokeir A,El-Assmy A,et al.882 POST PERCUTANEOUS NEPHROLITHOTOMY EXTENSIVE HEMORRHAGE:A STUDY OF RISK FACTORS[J].Journal of Urology,2007,6(2):576.
[9]湛海伦,杨飞,李腾成,等.肾上盏入路经皮肾镜取石术的手术技巧及安全性分析[J].中华腔镜泌尿外科杂志:电子版,2013,7(3):39-42.
[10]郑健忠,梁福律,范先明,等.多通道经皮肾镜与单通道经皮肾镜联合输尿管软镜治疗复杂性肾结石的效果比较[J].现代泌尿外科杂志,2016,21(8):593-596.
[11]王祥涛,魏巍,李明杰,等.老年肾结石患者接受PCNL术后出血的危险因素[J].中国老年学,2013,33(19):4733-4734.
[12]刘三河.有计划的二期单通道PCNL治疗上尿路结石的经验总结[D].沈阳:中国医科大学,2014.
[2]章俊,王阳赟,王曦龙,等.经皮肾镜碎石术中及术后出血需输血治疗的风险因素分析[J].现代泌尿外科杂志,2014,19(9):580-583.
[3]Nouralizadeh A,Ziaee S A M,Sharifi S H H,et al.Delayed postpercutaneous nephrolithotomy hemorrhage:Prevalence,predictive factors and management[J].Scandinavian Journal of Urology,2014,48(1):110.
[4]梁欣炜.经皮肾镜取石法手术治疗肾结石效果及出血因素分析[J].黑龙江医学,2016,40(6):507-508.
[5]Akman T,Binbay M,Sari E,et al.Factors affecting bleeding during percutaneous nephrolithotomy:single surgeon experience[J].Journal of Endourology,2011,25(2):327-333.
[6]Yamaguchi A,Skolarikos A,Buchholz N P,et al.Operating times and bleeding complications in percutaneous nephrolithotomy:a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study[J].Journal of Endourology,2011,25(6):933-939.
[7]邢兆辉.联合微通道及标准单通道PCNL治疗糖尿病鹿角形肾结石疗效分析[J].糖尿病新世界,2016,19(11):52-53.
[8]El-Nahas A,Shokeir A,El-Assmy A,et al.882 POST PERCUTANEOUS NEPHROLITHOTOMY EXTENSIVE HEMORRHAGE:A STUDY OF RISK FACTORS[J].Journal of Urology,2007,6(2):576.
[9]湛海伦,杨飞,李腾成,等.肾上盏入路经皮肾镜取石术的手术技巧及安全性分析[J].中华腔镜泌尿外科杂志:电子版,2013,7(3):39-42.
[10]郑健忠,梁福律,范先明,等.多通道经皮肾镜与单通道经皮肾镜联合输尿管软镜治疗复杂性肾结石的效果比较[J].现代泌尿外科杂志,2016,21(8):593-596.
[11]王祥涛,魏巍,李明杰,等.老年肾结石患者接受PCNL术后出血的危险因素[J].中国老年学,2013,33(19):4733-4734.
[12]刘三河.有计划的二期单通道PCNL治疗上尿路结石的经验总结[D].沈阳:中国医科大学,2014.