Guo Y F, Si T G, Zhang X J
Department of Interventional Therapy, Tianjin Cancer Hospital Airport Hospital,Tianjin 300308, China Department of Vascular Surgery, Tianjin Nankai Hospital, Tianjin 300102, China.
Department of Interventional Therapy, Tianjin Cancer Hospital Airport Hospital,Tianjin 300308, China.
Zhonghua Nei Ke Za Zhi. 2023 Oct 1;62(10):1215-1219. doi: 10.3760/cma.j.cn112138-20230618-00317.
To explore the factors associated with severe bleeding after percutaneous nephrolithotomy (PCNL) in male patients and evaluate the efficacy of interventional embolization. A retrospective case series study was conducted at Nankai Hospital of Tianjin, China, from January 2018 to October 2021. The clinical data of 230 male patients with upper urinary tract stones were analyzed. The observation indicators included age, hypertension, diabetes, renal function abnormalities, history of preoperative anticoagulant use, stone size, stone type, number of puncture channels, operation time and degree of hydronephrosis. To describe the clinical characteristics of bleeding after percutaneous nephrolithotomy in men, and analyze the factors associated with severe bleeding after PCNL. Single factor analysis was performed using the Chi-square () test, and multivariate analysis was performed using logistic regression analysis. Univariate analysis showed that diabetes mellitus (=4.90, =0.027), abnormal renal function (=18.32, <0.001), history of preoperative oral anticoagulants (=5.10, =0.024), abnormal bleeding and coagulation function (=8.22, =0.004) and the number of puncture channels (=22.08, <0.001) were the related factors affecting bleeding after PCNL. Multivariate logistic regression analysis showed that diabetes mellitus (=0.032), abnormal renal function (<0.001), and the number of puncture channels (<0.001) were the independent risk factors of bleeding after PCNL. Of the 28 patients with bleeding after PCNL, 25 were treated with interventional embolization, with a technical success rate of 100.0% and a clinical success rate of 89.3%. For patients with renal calculi and comorbid diabetes, renal function abnormalities, and multiple punctures, relevant preventive measures should be actively administered before PCNL to reduce the risk of postoperative bleeding. For patients with severe bleeding of the kidney after PCNL, TAE is a safe and effective minimally invasive treatment method.
探讨男性经皮肾镜取石术（PCNL）后严重出血的相关因素，并评估介入栓塞的疗效。于2018年1月至2021年10月在中国天津市南开医院进行了一项回顾性病例系列研究。分析了230例男性上尿路结石患者的临床资料。观察指标包括年龄、高血压、糖尿病、肾功能异常、术前抗凝药物使用史、结石大小、结石类型、穿刺通道数量、手术时间和肾积水程度。描述男性经皮肾镜取石术后出血的临床特征，并分析PCNL后严重出血的相关因素。采用卡方（χ²）检验进行单因素分析，采用logistic回归分析进行多因素分析。单因素分析显示，糖尿病（χ² = 4.90，P = 0.027）、肾功能异常（χ² = 18.32，P < 0.001）、术前口服抗凝药物史（χ² = 5.10，P = 0.024）、出血及凝血功能异常（χ² = 8.22，P = 0.004）和穿刺通道数量（χ² = 22.08，P < 0.001）是影响PCNL后出血的相关因素。多因素logistic回归分析显示，糖尿病（P = 0.032）、肾功能异常（P < 0.001）和穿刺通道数量（P < 0.001）是PCNL后出血的独立危险因素。PCNL术后出血的28例患者中，25例行介入栓塞治疗，技术成功率为100.0%，临床成功率为89.3%。对于合并糖尿病、肾功能异常及多次穿刺的肾结石患者，PCNL术前应积极采取相关预防措施以降低术后出血风险。对于PCNL术后肾脏严重出血的患者，TAE是一种安全有效的微创治疗方法。
