影响PCNL术后出血栓塞治疗的主要因素分析

目的 探讨决定经皮肾镜取石术（PCNL）后出血是否行栓塞治疗的因素。方法 回顾性分析我院2013年6月~2017年11月经皮肾镜术后出血患者共52例，根据术后止血方式分为保守治疗组40例和栓塞组12例。保守治疗组经保守治疗后出血停止，栓塞组选择肾动脉栓塞后止血成功。对两组患者的人口学资料、结石类型、手术相关因素及出血相关因素进行单变量分析，将栓塞治疗相关因素纳入多变量Logistic回归进一步分析。结果 两组患者的人口学资料、结石类型、手术相关因素、术前血红蛋白水平、出血天数、输血量比较，差异无统计学意义（P＞0.05）。栓塞组Hb下降值大于保守治疗组（44.08±11.86）g/L vs （19.05±12.72）g/L]，输血比例高于保守治疗组（8/12 vs 6/40），差异具有统计学意义（P＜0.05）。多变量Logistic回归分析结果显示，Hb下降值为决定PCNL术后出血是否栓塞的重要因素（OR=1.142，95%CI 1.038~1.256，P=0.006）。结论 Hb下降值为决定PCNL术后出血患者栓塞治疗的重要因素，在决定是否行栓塞治疗时应充分考虑Hb下降的程度。

Analysis of Main Factors Affecting Thromboembolism After PCNL

Abstract:Objective To investigate the factors that determine whether embolization after percutaneous nephrolithotomy (PCNL) is embolization. Methods A retrospective analysis of 52 patients with percutaneous nephrolithotomy in our hospital from June 2013 to November 2017 was divided into 40 patients in the conservative treatment group and 12 patients in the embolization group according to the postoperative hemostasis. Hemorrhage was stopped after conservative treatment in the conservative treatment group, and hemostasis was successful after superselective renal artery embolization in the embolization group. Univariate analysis of demographic data, stone type, surgical related factors and bleeding related factors were performed in the two groups, and embolization treatment related factors were included in multivariate logistic regression for further analysis.Results There were no significant differences in demographic data, type of stones, surgical related factors, preoperative hemoglobin levels, bleeding days, and blood transfusion between the two groups (P>0.05). The decrease in Hb in the embolization group was greater than that in the conservative treatment group (44.08±11.86) g/L vs (19.05±12.72) g/L], and the transfusion rate was higher than that in the conservative treatment group (8/12 vs 6/40),the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that the decrease in Hb was an important factor in determining whether or not embolization after PCNL was performed (OR=1.142, 95% CI 1.038~1.256, P=0.006).Conclusion The decrease of Hb is an important factor in determining the embolization treatment of postoperative patients with PCNL. The degree of Hb decline should be fully considered when deciding whether to treat embolization.