目的 探讨经皮肾镜碎石取石术（PCNL）严重出血的有关风险因素，为预防和减少因PCNL而导致严重出血提供依据。方法 回顾性选取 2014年 8月至 2017年 8月收住我院行 PCNL的 650例上尿路结石患者资料。对患者一般状况，如年龄、性别、孤肾、高血压、糖尿病、术前凝血功能、术前肌酐值、肾积水程度、泌尿系感染等，结石的多少、大小、位置、形态，术者操作因素（术中通道数目、单通道的大小、单通道的入路、单通道的穿刺位置、分期手术、手术时间）进行单因素 χ2检验，再对有意义的指标行多因素 Logistic回归分析。结果 χ2检验显示高血压、糖尿病、术前凝血功能异常、术前肌酐值 >115 μmol/L即肾功能不全、泌尿系感染、中重度肾积水、多发肾结石、结石位于肾盂和肾盏、术中多通道、术中较大穿刺通道、二期手术、手术时间超过 90min与 PCNL术后严重出血有关（P<0.05）。Logistic回归分析，术中较大穿刺通道、手术时间超过90 min、泌尿系感染、肾功能不全与PCNL术后严重出血有关（P<0.05）。结论 术中较大穿刺通道、手术时间超过 90 min、泌尿系感染、肾功能不全是 PCNL术后严重出血的危险因素。
Objective To evaluate factors contributing to bleeding after percutaneous nephrolithotomy(PCNL) and to provide evidence for prevention and reducing severe hemorrhage caused by PCNL. Methods The medical records of 650 patients with upper urinary calculi underwent PCNL in a single center from August 2014 to August 2017 were retrospectively reviewed. 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, urinary tract infection), stone factors(number of stone, stone size, stone location, stone shape)and factors relative to operation(number of tract, the size of tract, calyceal access, costal entries, previous operation, and operation time). In addition, multiariable Logistic regression analysis was used to evaluate the above positive factors. Results In chi-square analysis, hypertension, diabetes, preoperative blood coagulation dysfunction, preoperative creatinine values > 115 μmol/L or renal dysfunction, urinary tract infection, moderate to severe hydronephrosis, multiple kidney stones, combination of calculi in renal pelvis and calyces, multi-tracts, the larger puncture tract, repeated surgery and the operation time >90 min associate with severe hemorrhage caused by PCNL (P<0.05). In multiariable Logistic regression analysis, larger puncture tract, operation time over 90 min, urinary tract infections and renal dysfunction were independent risk factors for postoperative severe hemorrhage caused by PCNL (P<0.05). Conclusion The larger size of tract, operation time over 90 min, urinary tract infection and renal dysfunction are the independent risk factors for severe hemorrhage caused by PCNL during postoperative period.
