Analysis Of Influencing Factors Of Renal Pseudoaneurysm Hemorrhage After Percutaneous Nephrolithotripsy And Diagnostic Of Bedside Color Doppler Ultrasonography

Objective:To analyze the risk factors of renal pseudoaneurysm hemorrhage after percutaneous nephrolithotripsy and the clinical value of bedside color Doppler Ultrasonography in the diagnosis of renal pseudoaneurysm hemorrhage after percutaneous nephrolithotripsy(percutaneous nephrolithotomy,PCNL).Methods:1.A retorspective study of chlnical data of 365 patients with renal calculi trerted by percutaneous nephrolithotomy(PCNL)from November 2017 to November 2019 in Southern Hospital of Southern Medical University were enrolled into the study,11 of them suffered PCNL-related renal pseudoaneurysm hemorrhage.The general data of the patients include sex,age,BMI,history of hypertension,history of diabetes,urinary tract infection,renal insufficiency,degree of hydronephrosis,type of kidney stone,S.T.O.N.E.The operation-related factors including operation time,dilatation method and lithotripsy were analyzed by univariate analysis,and the statistically significant factors of postoperative renal pseudoaneurysm bleeding were screened out,and then multiple factor Logistic regression analysis was carried out to explore the independent risk factors about PCNL-related renal pseudoaneurysm hemorrhage.2.11 patients with renal hemorrhage after PCNL treated by interventional embolization in Southern Hospital from May 2018 to November 2019 were enrolled into the study.Data of 9 patients,including the bedside color Doppler Ultrasonography,clinical data and Digital Subtraction Angiography(DSA)were analyzed retrospectively.Results:1.Among 365 patients underwent percutaneous nephrolithotomy(PCNL),11 of them sufferde PCNL-related renal pseudoaneurysm hemorrhage,and the total bleeding rate of 3.01%.Statistical analysis showed that diabetes mellitus(P=0.019,OR=5.416),hypertension(P=0.021,OR=5.702),urinary tract infection(P=0.028,OR=4.906),cast stone(P=0.025,OR=12.827)and simple dilatation(P=0.025,OR=6.778)were independent risk factors for bleeding of renal pseudoaneurysm after PCNL.The statistical analysis showed that diabetes(0.019),hypertension(0.021),urinary tract infection(4.906),cast stone(12.827)and two-step dilatation(6.778)were independent risk factors of PCNL-related renal pseudoaneurysm hemorrhage.2.Eleven patients who were cured by renal artery embolization(7 cases with pseudoaneurysm,no cases of arteriovenous fistulaand 4 cases of simple arterial injury).All participants were examined by bedside color Doppler Ultrasound before arterial embolization.7 cases of renal pseudoaneurysm were initially diagnosed by bedside color Doppler Ultrasound and finally confirmed by renal arteriography.Conclusion:The main results are as follows:1.Diabetes,hypertension,urinary tract infection,cast stone and two-step dilatation were the independent risk factors of renal pseudoaneurysm hemorrhage after PCNL percutaneous nephrolithotripsy.2.the patients should be comprehensively evaluated before operation,and the patients with independent risk factors of renal pseudoaneurysm hemorrhage after percutaneous nephrolithotomy should be fully prepared during the perioperative period.the operator should choose the specific operation plan according to the characteristic data of the patient’s renal stone and the operator’s proficiency to different operation methods,in order to reduce the occurrence of operation-related renal pseudoaneurysm hemorrhage.3.Bedside color Doppler Ultrasound is a straight,simple,repeatable and rapid method,and has good consistency with DSA.It has a great superiority and clinical value in the diagnosis of renal pseudoaneurysm.