Abstract：Objective:To investigate the factors for bleeding during minimally invasive percutaneous nephrolithotomy (MPCNL). Methods:The clinical data of 360 patients who underwent MPCNL by a single surgeon from September 2011 to May 2012 were analyzed retrospectively. The clinical factors for bleeding included age, body mass index (BMI), hypertension, diabetes, hepatic insufficiency, renal insufficiency, urinary infection, history of open surgery in kidney, thickness of the renal parenchyma, hydronephrosis and stone size. The surgery-related factors for bleeding included the approach to suspected renal calix, size and number of tract, operative time, operation complications, and operation staging. The relation between the factors and bleeding during MPCNL was analyzed. Results:All the procedures were successfully completed. Multiple linear regression analysis showed that stone size (P=0.031), hydronephrosis (P=0.024), thickness of renal parenchyma (P=0.000), diabetes (P=0.038), operative time (P=0.035), number of tract (P=0.026), operation staging (P=0.000), and operation complications (P=0.000) significant affected blood loss. Conclusions:The size of stone, hydronephrosis, thickness of renal parenchyma, diabetes, operative time, number of tract, operation staging, and operation complications are the main risk factors for bleeding in MPCNL. Avoiding operation complications, reducing tracts and operative time, and selecting staging operation may reduce the risk of bleeding during MPCNL.
[1]邹晓峰,黄明,李逊,等.经皮肾微造瘘输尿管镜取石术治疗上尿路结石.中华泌尿外科杂志,2003,24(10): 693. [2]Turna B, Nazli O, Demiryoguran S, et al. Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology, 2007, 69(4): 603-607. [3]Rosette J, Assimos D, Desai M, et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol, 2011, 25(1): 11-17. [4]Zhong W, Zeng G, Wu W, et al. Minimally invasive percutaneous nephrolithomy with multiple mini tracts in a single session in treating staghorn calculi. Urol Res, 201l, 39(2): 117-122. [5]Park S, Pearle MS. Imaging for percutaneous renal access and management of renal calculi. Urol Clin North Am, 2006, 33(3): 353-364. [6]Patel U, Walkden RM, Ghani KR, et al. Three-dimensional CT pyelography for planning of percutaneous nephrostolithotomy: accuracy of stone measurement, stone depiction and pelvicalyceal reconstruction. Eur Radiol, 2009, 19(5): 1280-1288. [7]刘兆琼, 钟林坚, 陈丽, 等. 沿肾盏长轴方向经乳头穿刺在微创经皮肾镜取石术中的应用(附视频). 中华腔镜泌尿外科杂志(电子版), 2012, 5(6): 11-13. [8]Hegarty NJ, Desai MM. Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures. J Endourol, 2006, 20(10): 753-760. [9]Agrawal MS, Agrawal M. Are multiple nephrostomy tubes necessary after multitract percutaneous nephrolithotomy? A randomized comparison of single versus multiple nephrostomy tubes. J Endourol, 2009, 23(11): 1831-1834. [10]燕翔,郭宏骞,李笑弓,等.经皮肾微造瘘输尿管镜碎石术失血因素分析.中华泌尿外科杂志,2008,29(4): 254-258. [11]徐桂彬,李逊,何朝辉,等.微创经皮肾镜取石术出血量影响因素的分析.中华泌尿外科杂志,2007,28(7): 456-459. [12]邹晓峰,刘佛林,袁源湖,等.不置肾造瘘管和常规微创经皮肾镜取石术的对照研究.临床泌尿外科杂志,2010,25(11): 818- 820. [13]文博,黄小佳,邱建忠,等.微通道和标准通道PCNL治疗复杂性肾结石的比较.中华腔镜泌尿外科杂志(电子版), 2009, 3(3): 200-203. [14]曾国华,李逊,何朝辉,等.微创经皮肾取石术和传统经皮肾镜取石术对肾皮质损伤的比较.中华实验外科杂志,2004, 21(12): 155l-l552. [15]Kukreja R, Desai M, Patel S, et al. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol, 2004, 18(8): 715-722. [16]Tolga A, Murat B, Muzaffer A, et al. Variables that influence operative time during percutaneous nephrolithotomy: An analysis of 1897 cases. J Endourol, 2011, 25(8): 1269-1273. [17]吴玉婷,邹晓峰,张国玺,等.软性输尿管镜技术在小儿上尿路结石腔内治疗中的应用.中华泌尿外科杂志,2013, 34(11): 827-830.
