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

目的探讨经皮肾镜碎石(PCNL)术中及术后出血患者需输血治疗的风险因素。方法回顾性分析2010年1月至2013年12月复旦大学附属上海市第五人民医院应用PCNL术治疗肾结石的129例患者(共139次手术)的临床资料。对患者自身因素,如年龄、性别、体质量指数(BMI)、结石大小类型、是否合并高血压、糖尿病、肾功能不全、泌尿道感染以及手术相关因素如穿刺定位方式、穿刺肾盏位置、通道大小、手术时间及术者经验等相关因素进行单变量及多变量回归分析,分析上述各因素与是否输血之间的关系,找出影响手术出血的风险因素。结果 139例次手术均由同一名主刀医师顺利完成,均行单通道PCNL术,术中或术后输血治疗的患者有13例,输血率9.4%。单变量分析中,鹿角形结石(P0.001)、合并糖尿病(P=0.002)、通道大小(P=0.035)及手术时间(P=0.003)是影响出血的主要因素;而患者年龄、性别、BMI、合并高血压、肾功能不全、泌尿系感染、穿刺定位方式、穿刺肾盏位置及术者经验不是出血的风险因素。多变量回归分析中,鹿角形结石(OR=5.47)、合并糖尿病(OR=6.16)及手术时间过长(OR=1.03)可显著增加PCNL出血的风险。结论患者合并有糖尿病史、鹿角形结石、及手术时间过长均能增加PCNL术中、术后出血风险。

Risk factors affecting blood loss during and after percutaneous nephrolithotomy

Objective To investigate the risk factors affecting bleeding during and after percutaneous nephrolithotomy （PCNL）. Methods The clinical data of 129 patients undergoing 139 PCNL procedures in our hospital during Jan. 2010 to Dec. 2013 were retrospectively reviewed. The following factors were analyzed, including patients＇ age, sex, BMI, stone type, hyper- tension status, diabetes status, renal insufficiency, urinary tract infection, and the operative factors including method of puncture, calix of puncture, size of passage, operation time, surgeons＇ experience. Univariate analysis and multivariate regression analysis was used to assess the correlation with total blood loss. Results All the 139 PCNL procedures were successfully performed with single tract by the same surgeon. A total of 13 patients （9.4%）received blood transfusion. Univariate analysis showed that staghorn stones （P〈0.001）, diabetes mellitus （P=0. 002）, size of passage （P〈0. 035）, operation time （P= 0. 003）, were the risk factors affecting blood loss. Age, sex, BMI, hypertension status, renal insufficiency, urinary tract infection, method of puncture, calix of puncture, and surgeons＇ experience were not risk factors. Multivariate regression analysis showed that staghorn stones （ OR = 5.47）, diabetes mellitus （ OR = 6.16） and operation time （ OR = 1.03） significantly increased risk of bleeding. Conclusion Staghorn stones, diabetes mellitus and operation time were the risk factors affecting bleeding during and after percutaneous nephrolithotomy.