Clinical Analysis And Countermeasure Research Of Massive Haemorrhage During Percutaneous Nephrolithotomy By Endoscopy And Holmium Laser

Objective: Observe the massive haemorrhage caused by percutaneous nephrolithotomy(PCNL) by endoscopy and holmium laser, study the effective countermeasures in decreasing the intraoperative and postoperative bleeding of PCNL from the aspect of calculi, diabetes mellitus, examination item, technical operation and so on. Summarize the correlation and the experience and lessons in patients with renal vascular anatomy, and then provide guidance for clinical prevention and treatment of haemorrhage associated PCNL.Methods : Collect clinical data of intraoperative and postoperative bleeding patients from 1012 percutaneous nephrolithotomy patients in our urology department from July 2009 to July 2014. Then divided them into complexity calculi group and uncomplexity calculi group, into the group with diabetes and the group without diabetes according to the situation with diabetes mellitus, into the conventional group(the control group, including color doppler ultrasound, IVP, CT) and the perfect examination group(the observation group, including color doppler ultrasound, IVP, CT and 3 DCT or CTU) according to the preoperative examination item, and into the group year by year according to the operation time, technical operation proficiency. Respectively statistic and analyze the incidence of bleeding, and discuss the relationship of PCNL bleeding with calculi, diabetes mellitus, examination item, technical operation and so on. According to patient’s bleeding time and related processing, respectively analysis the law of renal vascular anatomy in patients, and preliminarily explain its relationship with massive hemorrhage. Results: 1012 side PCNL operation were successful in this study group, with a total of 36 side bleeding occurs, and 15 side of intraoperative bleeding, 21 side of postoperative bleeding, 17 side of postoperative delayed hemorrhages contained. The totality incidence of bleeding during PCNL is 3.56%; The incidence is higher(5.52%) for patients with complexity calculi; The incidence of delayed massive haemorrhage has been increased postoperatively in the diabetes mellitus patients; This incidence is lower(1.81%) for patients whose preoperative examination is more perfect; Along with the extension of time in carrying out technology, PCNL associated bleeding incidence decline year by year. The intraoperative and postoperative bleedings of patients with respective renal vascular anatomy are all different, and the disposals are different too. Conclusions: Correctly handle complicated calculi, improve the preoperative examination and fully combined with intraoperative B-ultrasonic wave guidance, control blood glucose stable, increase the technical level of operators can effectively decrease the occurrence of haemorrhage associated with PCNL.Hemorrhage patients have some certain the reason in renal vascular anatomy, and make correct judgment in a timely or classify in place can help stop bleeding quickly and efficiently.