Analysis Of Complications Of Percutaneous Nephrolithotripsy

Objective:To discuss the complications and prevention of percutaneous nephrolithotripsy.Methods:The clinical data of 1037 patients with urolithiasis underwent percutaneous nephrolithotomy in the second affiliated Hospital of Kunming Medical University from January 2016 to December 2016 were retrospectively analyzed.The clinical data of 1037 patients in our hospital were collected by Excel software:sex,age,hospitalization time,operation time,diabetes mellitus,staghorn stone,preoperative urinary tract infection,intraoperative and postoperative complications,PCNL staging,stone residue.Then we calculate the probability of complications,analyze the risk factors of complications,and take preventive measures to deal with complications.Results:1167 operations were performed in 1037 patients.The operative time was 70-240 mins,the mean time was 107±45.6 mins.686 cases were longer than 90 minutes.The average hospital stay was 11.3 days.There were 99 patients with age>60 years old.There were 228 cases of staghorn calculi.There were 84 cases of diabetes mellitus.8 cases of massive hemorrhage occurred during operation.6 cases were cured after blood transfusion and hemostasis.One patient was cured by renal artery embolization and hemostasis.1 case underwent right nephrectomy because of intraoperative bleeding of the right kidney.There were 16 cases of postoperative bleeding.10 cases were cured by renal artery embolization and blood transfusion.4 cases were cured after blood transfusion and hemostasis.2 cases did not rebleeding after conservative treatment.There were 824 cases of infection before operation.There were 183 cases of postoperative infection,including 134 cases of male,31 cases of age>60 years old,53 cases of staghorn calculi,165 cases of infection before operation,28 cases of diabetes before operation and 137 cases of operation time>90min.The influencing factors of infection after operation were statistically analyzed and chi-square test was used to show that age>60 years old,staghorn stone,infection before operation,diabetes mellitus and operative time ≥90min were statistically significant,but gender was not statistically significant.There were 31 patients with sepsis,including 13 males,18 females,2 antler calculi and 29 patients with operative time>90min.31 patients were cured after anti-infection therapy.The influencing factors of sepsis after operation were statistically analyzed and chi-square test was used to indicate that there was statistical significance in women,staghorn calculi and operative time>90min.There were 8 patients with septic shock and 8 patients with operation time>90min.The patients were cured by vasoactive drugs and antiinfective therapy.The influencing factors of septic shock after operation were statistically analyzed and chi-square test was used to indicate that the operative time>90min was statistically significant.There were 576 patients with residual stone,the residual rate of primary stone was 55.54%.The residual rate of stone was 8.39%after reoperation.The total stone removal rate was 91.61%.3 cases had pleural injury.One case had sustained bleeding after closed thoracic drainage and was cured by resection of left pulmonary bullae.The other 2 cases were cured by closed thoracic drainage.Abdominal viscera injury occurred in 1 case.Right nephrectomy was performed on the right side of the kidney during percutaneous nephroscopic puncture.The exosmosis of urine occurred in 1 case.The patient developed abdominal distention after operation and was cured after treatment with strong heart,diuretic,reduced sodium and chlorine intake.There were 2 cases of water poisoning.One patient was cured with sodium bicarbonate,cardio and diuretic treatment.The other patient received cardiac strengthening,diuretic therapy,reduced sodium and chlorine intake treatment.After that the disease was cured.Postoperative bleeding,pleural injury,abdominal organ injury and other puncture complications occurred in 28 patients with one-stage PCNL,which was related to urologist’s level of operation.The influencing factors of puncture complications were statistically analyzed and chi-square test was used to show that staghorn calculi,one-stage PCNL,operative time>90min had statistical significance.Gender is not statistically significant for puncture complications.Conclusions:Infection,intraoperative and postoperative bleeding are common complications of PCNL and should be paid attention to and take active preventive measures.Although the incidence of residual stones is high,the advantages of percutaneous nephrolithotripsy and minimally invasive lithotripsy make it the first choice in the treatment of complex stones.Staghorn calculi,one-stage PCNL,operative time>90min were all risk factors of puncture complications.Gender is not a risk factor for puncture complications.Bleeding,pleural injury,abdominal organ injury occurred at one-stage PNCL,which was related to urologist’s level of operation.Age>60 years old,staghorn calculi,preoperative infection,diabetes and operative time>90min were risk factors for postoperative infection.Gender is not a risk factor for postoperative infection.Women,staghorn calculi and operative time>90min were risk factors for sepsis.Operative time>90min was a risk factor for septic shock after operation.