| Objective: Haemorrhage is a serious complication of percutaneous nephrolithotomy(PCNL).In this study,we analyzed the clinical data of patients who underwent PCNL successfully,and conducted a Meta-analysis of the literature on risk factors for severe bleeding in PCNL to investigate the risk factors for bleeding in PCNL and to provide a basis for preventing and reducing bleeding.Method:1.The clinical data of patients with confirmed kidney stones or upper ureteral stones and successful PCNL in the Department of Urology,Gansu Provincial People’s Hospital between October 2017 and October 2022 were retrospectively analyzed,and patients were divided into severe bleeding and non-severe bleeding groups by whether severe bleeding occurred.The patients’ general factors(age,gender,BMI,hypertension,diabetes mellitus,urinary tract infection,preoperative coagulation function,renal function,degree of hydronephrosis),stone factors(stone location,number of stones,stone size,whether deerstalker-type stones),intraoperative factors(number of channels,size of channels,puncture location,operative time)were analysed unilaterally,and then the statistically significant indicators were multi-factor logistic regression analysis;2.To search the relevant literature on embolization treatment for severe bleeding in PCNL in the databases of CNKI,WANFANG,China Science and Technology Journal Database,China Biomedical Literature,EMBASE,Pub Med,Web Of Science,Cochrane Library,etc.The search period was from the establishment of the database to 07,2022,and the retrieved literature was carried out according to the inclusion and exclusion criteria established The literature was initially screened according to the inclusion and exclusion criteria,and those that met the requirements were evaluated for quality,and the relevant data in the high-quality literature were extracted,and Meta-analysis was performed using the software Rev Man 5.4 provided by the Cochrane Collaboration Network,while the results of each study in the included literature were identified and judged for publication bias.Results:1.365 patients who underwent successful PCNL for renal stones or upper ureteral stones were included in this clinical study.35 patients had severe bleeding(bleeding volume ≥ 400ml),representing a severe bleeding rate of 9%.Twenty-nine patients with severe bleeding improved after symptomatic treatment.Six patients were treated with blood transfusions for excessive blood loss,and two of them had poor results after treatment with drugs and blood transfusions to control the bleeding with arterial catheter embolization,with an embolization rate of 0.5%.A univariate analysis of the patients’ general,stone and intraoperative factors concluded that the risk factors for severe bleeding in PCNL(p < 0.05)included history of diabetes mellitus,history of urinary tract infection,preoperative coagulation abnormalities,degree of hydronephrosis(moderate to severe),stone size(≥20 mm),deerstalker-type stones,intraoperative multiple access,and access size(F20-F22).Multi-factor logistic regression analysis of the above factors showed that patient history of diabetes,history of urinary tract infection,deerstalker-type stones and intraoperative establishment of multiple channels were independent risk factors for severe bleeding in PCNL.2.In this Meta-analysis study,a total of 11 papers,9 in English and 2 in Chinese,were screened according to the established inclusion and exclusion criteria,and 18,564 cases were included in the study.6 risk factors that may lead to severe bleeding in PCNL treated with embolization were discussed,and Meta-analysis was performed by Revman 5.4 software,and the results showed that gender(male),The combined effect(Odds ratio(OR)values with 95%confidence intervals(CI)for history of hypertension,history of diabetes mellitus,intraoperative multiple access,deerstalker type stones,and urinary tract infection were 1.35 [0.94,1.94],1.54[0.94,2.52],3.64 [1.29,10.29],3.31 [1.34.8.18],8.85 [2.53,31.00],2.27 [1.43,3.61],where the risk factors with statistically significant differences(p<0.05)were history of diabetes(p=0.01),multiple intraoperative access(p=0.009),antler-type stones(p=0.0006),history of urinary tract infection(p= The above factors were not significantly biased and can be considered as risk factors for severe bleeding requiring embolization for PCNL,while gender(male)(P=0.10)and history of hypertension(P=0.09)were not statistically significant and cannot yet be considered as risk factors for severe bleeding requiring embolization.Conclusion:1.The univariate analysis in this clinical study showed that patients’ history of diabetes mellitus,history of urinary tract infection,preoperative coagulation abnormalities,degree of hydronephrosis(moderate to severe),size of stones(≥20 mm),complex stones(antler-type stones),intraoperative multichanneling and channel size(F20-F22)were risk factors for severe bleeding in PCNL.Multi-factor Logisitc regression analysis showed that four factors,namely history of diabetes,history of urinary tract infection,deerstalker-type stones and intraoperative multiple passages,were independent risk factors for severe bleeding during PCNL.2.The results of the present Meta-analysis study allow us to conclude that the four factors of history of diabetes,history of urinary tract infection,deerstalker-type stones,and intraoperative multichanneling are risk factors for severe bleeding requiring embolization in PCNL,whereas the factors of gender and hypertension cannot yet be considered to be associated with severe bleeding in PCNL.3.The results of this clinical study and the Meta-analysis agree that the four factors of patient’s history of diabetes mellitus,history of urinary tract infection,antler-type stones,and intraoperative multiple access are risk factors for severe bleeding or embolization of PCNL,and the risk of severe bleeding due to these factors should be noted in the perioperative period of PCNL. |
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