Hu Yudong, Wang Xiaofeng, Chen Yujie, Zhong Yong, Zhu Faming, Yuan Ye, Ye Jin, Yang Fan, Li Jun
Department of Urology, The Thirteenth People's Hospital, Chongqing, China.
Medicine (Baltimore). 2025 Aug 1;104(31):e43606. doi: 10.1097/MD.0000000000043606.
Percutaneous nephrolithotomy (PCNL) is commonly used for the treatment of large loads of upper urinary tract stones. Bleeding is one of the major complications of PCNL, and severe bleeding affects patient life and recovery in the perioperative period. There are few high-quality studies on the risk factors for severe bleeding with PCNL, and the conclusions of multiple studies are not entirely consistent. This study assessed the risk factors for severe bleeding complications associated with PCNL through a meta-analysis.
Computer-based search of PubMed, Embase, Web of Science, and The Cochrane Library were conducted, with the search period ranging from the establishment of the databases to May 1, 2025. Statistical analysis was performed using Revman 5.4 software.
A total of 22 studies were included, all of which were case-control studies, with 878 cases in the severe bleeding group and 10,746 cases in the control group. Meta-analysis showed that the combination of diabetes (odds ratios [OR] = 3.27, 95% confidence interval [CI], 2.45-4.37), hypertension (OR = 2.39, 95% CI, 1.68-3.42), urinary tract infection (OR = 1.91, 95% CI, 1.30-2.81), renal anomaly (OR = 3.99, 95% CI, 2.22-7.16), multiple stones (OR = 2.10, 95% CI, 1.08-4.11), stone size (mean difference = 0.64, 95% CI, 0.03-1.25), staghorn stones (OR = 2.73, 95% CI, 2.15-3.47), solitary renal stones (OR = 3.60, 95% CI, 1.91-6.76), multiple accesses (OR = 3.94, 95% CI, 2.46-6.34), and operative time (mean difference = 22.11, 95% CI, 12.96-31.26) were the risk factors for severe bleeding associated with PCNL (P < .05). Hydronephrosis (OR = 0.36, 95% CI, 0.18-0.75) was a protective factor for severe bleeding with PCNL (P < .05).
Diabetes, hypertension, urinary tract infections, renal anomaly, hydronephrosis, number of stones, stone size, staghorn stones, solitary renal stones, number of access, and operative time are associated with PCNL complicating severe bleeding, which requires clinical attention. Early identification and intervention for these factors are necessary to reduce the incidence of severe bleeding complications during PCNL and improve perioperative patient safety.
经皮肾镜取石术（PCNL）常用于治疗大量上尿路结石。出血是PCNL的主要并发症之一，严重出血会影响患者围手术期的生活及康复。关于PCNL严重出血危险因素的高质量研究较少，多项研究结论并不完全一致。本研究通过荟萃分析评估了与PCNL相关的严重出血并发症的危险因素。
通过计算机检索PubMed、Embase、Web of Science和Cochrane图书馆，检索时间范围为各数据库建立至2025年5月1日。使用Revman 5.4软件进行统计分析。
共纳入22项研究，均为病例对照研究，严重出血组878例，对照组10746例。荟萃分析显示，糖尿病（比值比[OR]=3.27，95%置信区间[CI]，2.45 - 4.37）、高血压（OR = 2.39，95% CI，1.68 - 3.42）、尿路感染（OR = 1.91，95% CI，1.30 - 2.81）、肾脏异常（OR = 3.99，95% CI，2.22 - 7.16）、多发结石（OR = 2.10，95% CI，1.08 - 4.11）、结石大小（平均差 = 0.64，95% CI，0.03 - 1.25）、鹿角形结石（OR = 2.73，95% CI，2.15 - 3.47）、孤立肾结石（OR = 3.60，95% CI，1.91 - 6.76）、多次穿刺（OR = 3.94，95% CI，2.46 - 6.34）及手术时间（平均差 = 22.11，95% CI，12.96 - 31.26）是与PCNL相关的严重出血危险因素（P <.05）。肾积水（OR = 0.36，95% CI，0.18 - 0.75）是PCNL严重出血的保护因素（P <.05）。
糖尿病、高血压、尿路感染、肾脏异常、肾积水、结石数量、结石大小、鹿角形结石、孤立肾结石、穿刺次数及手术时间与PCNL并发严重出血相关，需临床关注。早期识别并干预这些因素对于降低PCNL期间严重出血并发症的发生率及提高围手术期患者安全性是必要的。
