Analysis Of Risk Factors Of Complications After Tubeless Percutaneous Nephrolithotripsy With Large Channel

Background:In the diagnosis and treatment of urology,urinary stones are more common than other diseases,and they also have a higher incidence in the world.Percutaneous nephrolithotomy is recognized as the preferred option for the treatment of large-load stones in the upper urinary tract,and its surgical methods are also developing towards minimally invasive and tubeless treatment.Therefore,through retrospective analysis,this study aimed to find the risk factors related to common complications of large-channel tubeless percutaneous nephrolithotomy under plasma electrocoagulation hemostasis,aiming to minimize the incidence of common postoperative complications in clinical work and promote faster recovery.Objective:To explore the risk factors and prevention strategies for common complications of large-channel partial tubeless percutaneous nephrolithotomy under plasma electrocoagulation hemostasis.Methods:This study is retrospective and collects and analyses clinical data from patients who presented to Qingdao Municipal Hospital for urinary stones from January 1,2014 to December 31,2022 and had percutaneous nephrolithotripsy performed by the same experienced urological surgeon.A total of 126 patients who underwent standard PCNL(without channel hemostasis)were set up as the control group.The 223 patients who underwent partial tubeless PCNL(plasma electrocoagulation hemostasis was used to stop the bleeding channel during surgery)were set as the observation group,and the observation group was divided into non-complication group and complication group with reference to the modified Clavien score,and the relationship between the age,sex,body mass index,fasting blood glucose,hydronephrosis,history of hypertension,operation time,intraoperative blood loss,stone diameter,preoperative urine culture results,whether it was multiple stones,whether it was a staghorn stone and other factors were compared with common postoperative complications.Count data are expressed in rate(%),and chi-square tests are used for comparison between count data.Nonnormally distributed metrics are represented by median(quartile),and the MannWhitney rank sum test is used for between-group comparisons.Correlation analysis uses Spearman-level correlation analysis.Univariate logistics regression analysis was carried out for the above factors,and the related factors of P<0.05 were then multivariate logistic regression analysis to obtain independent risk factors for complications after large-channel tubeless percutaneous nephroscopy under electrocoagulation hemostasis.When P<0.05 the difference is considered statistically significant.Results:A total of 349 cases were included,and compared with the data of the observation group and the control group,the large-channel partial tubeless percutaneous nephrolithotomy under plasma electrocoagulation hemostasis had advantages over standard PCNL in terms of analgesic drug dose,normal activity time,hospital stay,reduction of postoperative bleeding and reduction of interventional therapy.By comparing the differences of various parameters between the uncomplicated group and the complication group,it was found that the serum creatinine value,operation time,stone diameter,positive preoperative urine culture,multiple stones,and staghorn stones were positively correlated with the severity of complications,and the differences were statistically significant(p<0.05).The six influencing factors screened out by univariate logistic regression analysis were included as independent variables in this multivariate logistic regression analysis.The results showed that the operation time(OR=1.024,95%CI1.006-1.043,P=0.010),stone diameter(OR=1.083,95%CI1.026-1.143,P=0.004),positive preoperative urine culture(OR=5.356,95%CI1.699-16.886,P=0.004)and staghorn stones(OR=5.963,95%)CI1.613-22.044,P=0.007)was an independent risk factor for postoperative complications.Conclusions:Tubeless PCNL is a safe and effective surgical modality,and the use of plasma electrocoagulation to stop bleeding during surgery has advantages in reducing postoperative bleeding,hospital stay,postoperative analgesia and postoperative interventional treatment.This study found that preoperative serum creatinine value,operation time,stone diameter,positive preoperative urine culture,multiple stones,and staghorn stones were risk factors for complications.Positive preoperative urine culture(P=0.004),operation time(P=0.010),stone diameter(P=0.004),and staghorn stones(P=0.007)were independent risk factors for complications after tubeless percutaneous nephrolithotomy in large channels under electrocoagulation and hemostasis.Therefore,it is necessary to reasonably control the patient’s surgical indications before surgery,fully understand the relevant risk factors,and do a good job in preoperative assessment.Rationalized individual treatment of patients is of great significance to reduce the occurrence of surgical complications.