| Part Ⅰ The animal experiment on renal arterial injury to the tract of percutaneous nephrostomyObjective:To investigate the extent of renal arterial injury incurred by different size of nephrostomy tracts from 10 F to 32F in vitro porcine kidneyMethods:To obtain fresh porcine kidneys,separate out the renal arterials and renal veins.renal arterials was perfused with physiologic saline and heparin sodium(500:1),till the renal perfusion fluid become clarify.An 18G needle was used to puncture the renal upper,mid and lower pole retrograde from the renal pelvis under vision,allow the passage of guide wire into the respective renal pole.then dilated the tracts with Amplatz dilator in antegrade from 8F,increased by 2F.Setting up 12 groups different size nephrostomy tracts from 10F to 32F,80 nephrostomy tracts for 14F,18F and 22F groups,40 nephrostomy tracts for other groups,3 tracts every kidney.constrast medium was injected into renal arterial in lml/s with high pressure syringe.at the same time record the result of digital subtraction angiography(DSA)to inspect and analysis the degree of renal arterial injury.For 14F,18F and 22F groups,methylene blue was injected into renal arterial in lml/s with high pressure syringe,and endoscopy to inspect the degree of renal arterial injury.Result:When the size of nephrostomy tracts is increased from 10F to 32F,the degree of arterial injury is also ag-gravated.With 24F compared to 14F,the number of injured renal artery were 2.16±1.08 and 0.81±0.28,respectively,t=7.6527,P<0.05).With 24F compared to 18F,the number of injured renal artery were 2.16± 1.08 and 1.12±0.59,respectively,t 5.53448,P<0.001.Conclusion:When the size of nephrostomy tract is increased,the degree of renal arterial injury is also heightened.When 18F tracts was compared to 24F tracts and 14F tracts compared to 24F tracts,obvious reduction of arterial injury is observedPart Ⅱ Analysis of the factors affecting hemorrhage during percutaneous nephrolithotomyObjective:Renal hemorrhage is one of the most common and worrisome complications of percutaneous nephrolithotomy(PCNL).This study attempted to identify variables that might influence hemorrhage during PCNL to help urologists establish preventative and treatment strategies for bleeding during PCNL procedures.Methods:The data of 234 patients(234 PCNL procedures)were retrospectively analyzed.Hemorrhage was estimated by the postoperative decrease in hematocrit factored by the quantity of any blood transfusion.Various preoperative and operative factors were assessed for their association with blood loss using univariate,forward multivariate regression and correlation analysis.Results:234 procedures were successfully performed.Single-tract was used in 198 cases and multiple-tract was used in 36 cases.158 cases were performed via 18 F access and 76 cases via 24 F access.The mean operative time was 72.5 min.The overall blood transfusion rate was 3.4%.The average hemoglobin(Hb)drop after percutaneous nephrolithotomy procedures was 16.52± 13.26 g/L.And stone size(P<0.001),renal parenchymal thickness(P=0.003),number of accesses(P=0.023),size of accesses(P<0.001 and operative time(P<0.001)were the risk factors affecting Hb drop.The following covariates including Hb drop:age、sex、BMI、hypertension status、calix of puncture、hydronephrosis、stone CT value、surgeon experience、diabetes status and urinary tract infection were not risk factors affecting Hb drop.Multivariate regression analysis showed that stone size(P=0.003),renal parenchymal thickness(P=0.019),number of accesses(P=0.029),size of accesses(P=0.016)and operative time(P=0.023)significantly increased risk of bleeding.Conclusions:stone size,renal parenchymal thickness,number of accesses,size of accesses and operative time were the risk factors affecting blood loss during percutaneous nephrolithotomy.Part Ⅱ:The clinical researchon hemorrhage and blood pressure changes recently of percutaneous nephrolithotomyObjective:To study the hemorrhage and blood pressure changes recently following percutaneous nephrolithotomy to the different size of nephrostomy tracts(14F、18F、24F).Methods:Between June 2014 and June 2016,158 patients who were candidates were selected for detection of peak intensity of Contrast-enhanced ultrasound of hemorrhage nudi and hemoglobin before and after operation.At the same time,systolic pressure,diastolic pressure,plasma rennin,Angiotensin Ⅱ and aldosterone were detected preoperative,1 month and 6 months postoperative of PCNL.All the patients had a definite diagnosis preoperatively by CTU.Urinary tract infection must be effectively controlled before PCNL.PCNL was performed in guiding of B-mode ultrasound.These cases had a random distribution to receive PCNL with single percutaneous tract of 14F、18F、24F.All operations are completed by the same doctor under general anesthesia.All the data were analyzed retrospectively with SPSS 17.0 software.And these enumeration data Was expressed with x±S.Multiple samples comparison between using single factor analysis of variance(one-way ANOVA),P<0.05,the difference was statistically significant.Result:At last,125 cases were enrolled,13 cases were excluded for complications such as infection,20 cases loss during the period of follow up,and the detail of these cases was in the attachment figure 6.When the size of nephrostomy tract is increased,the degree of hemoglobin drop of PCNL is heightened and the peak intensity of Contrast-enhanced ultrasoundis also increased.With 14F compared to 18F and 18F compared to 24F,the drop of hemoglobin and the increase of peak intensity,the difference has statistic significance.Followed up 6 months postoperative of PCNL,no obvious difference was found compared to preoperative to systolic pressure,diastolic pressure,plasma rennin,AngiotensinⅡ and aldosterone.Conclusion:When the size of nephrostomy tract is increased,the degree of hemoglobin drop of PCNL is heightened and the peak intensity of Contrast-enhanced ultrasoundis increased.With 14F compared to 18F and 18F compared to 24F,obvious reduction of perioperative bleeding is observed.Followed up 6 months postoperative of PCNL,no obvious difference was found compared to preoperative to systolic pressure,diastolic pressure,plasma rennin,Angiotensin Ⅱ and aldosterone. |
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