Related Factors And Clinical Intervention Analysis Of Severe Hemorrhage Caused By Percutaneous Nephrolithotomy

Background: Percutaneous nephrolithotomy(PCNL)has become the main treatment for the upper urinary tract calculi,especially in staghorn and multiple stones.However,due to the unique anatomical structure of the kidney and limited surgical space,severe postoperative bleeding is an important problem for urologists.There are many factors that can affect severe bleeding after PCNL,including the patient's general condition,stone factors and clinical experience of surgeons.Understanding the risk factors associated with severe bleeding caused by PCNL has great clinical significance for effective prevention and giving timely clinical intervention.But so far,the retrospective studies of severe postoperative bleeding caused by PCNL are limited and the conclusions are not consistent.Therefore,the present study is aimed to examine the relationship between severe bleeding and the related risk factors,and to provide clinical reference for prevention and treatment of postoperative severe bleeding.Objective: 1.To evaluate factors contributing to severe bleeding after PCNL and to provide evidence for clinician about prevention and reduction of severe hemorrhage caused by PCNL;2.To perform clinical intervention for patients with severe hemorrhage after PCNL and to observe the effects.Methods: 1.The medical records of 650 patients with upper urinary tract calculi who underwent PCNL in a single center from August 2014 to August 2017,were retrospectively reviewed.Firstly,Single factor chi-square test was employed to analyze the patients general characteristics(age,gender,solitary kidney,hypertension,diabetes,preoperative blood coagulation function,creatinine values,the degree of hydronephrosis,and urinary tract infection),stone factors(number of stone,stone size,stone location,and stone shape)and factors relative to operation(number of channel,the size of channel,calyceal access,costal entries,staging surgery,and operation time).Secondly,multi-factor Logistic regression analysis was used to evaluate the above positive factors;2.Patients with severe postoperative hemorrhage caused by PCNL were given appropriate clinical treatments in time.Results: 1.Of the 650 patients who underwent PCNL,serious bleeding occurred in 52 cases(8.0% of the total);2.Using chi-square analysis,hypertension,diabetes,preoperative blood coagulation dysfunction,preoperative creatinine values > 115 umol/L or renal dysfunction,urinary tract infection,moderate to severe hydronephrosis,multiple stones,combination of calculi in renal pelvis and calyces,multi-channels,the larger puncture channel,staging surgery and the operation time were shown to be associated with severe hemorrhage caused by PCNL(P < 0.05).Using multi-factor Logistic regression analysis,larger puncture channel,operation time over 90 min,urinary tract infections and renal dysfunction were found to be independent risk factors for severe postoperative hemorrhage caused by PCNL(P < 0.05);3.Of the 52 patients with severe bleeding,47 patients were treated with conservative treatment,such as brake,infusion hemostatic medicine,renal fistula tube compression,and blood transfusion,and the bleeding was controlled.The other 5 patients were treated with selective renal arterial embolization successfully.Conclusion: 1.Larger puncture channel,operation time over 90 min,urinary tract infection and renal dysfunction were key risk factors for severe hemorrhage after PCNL;2.Most patients with severe postoperative bleeding caused by PCNL were successfully managed with conservative treatment,only a small number of patients needed selective renal artery embolization(SRAE)to control the bleeding.