Analysis Of Influencing Factors Of Percutaneous Nephrolithotomy Bleeding And Preventive Treatment

Objective: To explore the influencing factors of percutaneous nephrolithotomy bleeding,take preventive measures,and improve the safety and effectiveness of surgery.Methods: Retrospectively collected 430 patients with upper urinary calculi who underwent Percutaneous nephrostolithotomy(PCNL)in our hospital from January 2015 to September 2019,All patients completed urological B-ultrasound,urinary plain film(KUB),intravenous pyelography(IVP),and urinary CT plain scan.The general conditions of patients include age,gender,history of diabetes,history of hypertension,urinary tract infection,degree of hydronephrosis,renal insufficiency,and solitary kidney.The stone status of the patient includes stones Morphology,number of stones,size of stones,location of stones;Surgery-related conditions include the size of the puncture channel,the path of the puncture channel,staged surgery,and operation time.Single factor analysis is performed to identify potential risk factors.Finally,the history of diabetes,urinary tract infection,stone morphology,stone size,staged surgery,and operation time were selected for multivariate Logistic regression analysis.Results: In 430 patients,the operation was successfully completed.Among them,37 patients had ≥400ml of intraoperative and postoperative bleeding,8.6% of total bleeding.15 patients improved with embolization,with an embolization rate of 3.5%.Eighteen patients were transfused,and the transfusion rate was 4.2%.Chi-square test results found History of diabetes(P=0.017),Urinary system infection(P = 0.004),Antler stones(P = 0.000),Stones larger than 2cm(P = 0.013),Staged surgery(P = 0.014),Operation time greater than 90min(P = 0.000)is a risk factor affecting bleeding.Multifactor Logistic Regression Analysis History of diabetes(OR = 2.596),Urinary system infection(OR = 2.377),Staghorn stones(OR = 4.519),Staged surgery(OR = 0.120),Operating time greater than 90 minutes(OR = 8.887)is an independent risk factor for PCNL during and after PCNL.Conclusion: A history of diabetes,urinary tract infections,staghorn stones,and surgery time greater than 90 minutes increase the risk of bleeding.Staged surgery can reduce bleeding.