经皮肾镜钬激光碎石术大出血临床分析及对策研究

摘要

Objective To provide guidance for clinical prevention and treatment of bleeding during percutaneous nephrolithotomy( PC-NL) . Methods The clinical data of 1 012 patients with intraoperative and postoperative bleeding during percutaneous nephrolithotomy in our urology department were collected,hemorrhoea occurred on 36 cases,the occurrence rate was 3. 56%. The incidence,correlation with cal-culi,diabetes mellitus,examination item,technical operation were analyzed and compared. Results The incidence was 5. 52% for patients with complicated calculi. The incidence of delayed massive haemorrhage has been increased postoperatively in the diabetes mellitus patients. This incidence was 1. 81% for patients with preoperative examination. Along with the extension of time in carrying out technology,PCNL asso-ciated bleeding incidence decreased year by year. Conclusion The occurrence of haemorrhage associated with PCNL could be decreased by correctly handling complicated calculi,preoperative examination,keeping blood glucose homeostasis and improving the manipulation ability of operator.%目的：分析经皮肾镜钬激光碎石术( PCNL)大出血的原因，为临床防治出血提供对策。方法我科2009年7月至2014年7月行经皮肾镜钬激光碎石取石术1012例，其中发生大出血36例，发生率为3.56%；本文收集这1012例经皮肾镜钬激光碎石取石术患者的临床资料，对其结石情况、合并糖尿病、检查项目、技术操作等情况分析比较。结果复杂性结石手术大出血发生率较高(5.52%)；合并糖尿病患者术后迟发性大出血发生率增加；术前检查较为完善的患者大出血发生率相对较低(1.81%)；随着此技术开展时间的延长，相关出血发生率逐年下降。结论正确处理复杂性结石、完善术前检查、维持血糖稳定、提高术者技术操作水平可有效减少PCNL大出血的发生。