Clinical Study Of The Severe Hemorrhage Predictive Factors And Embolization Treatment After Percutaneous Nephrolithotomy

Objective: To prevent the occurrence of hemorrhage,reduce blood transfusion rates,and improve the surgical outcomes of the percutaneous nephrolithotomy(PCNL).The first part investigated the predictive factors of severe hemorrhage after PCNL.The second part is based on the clinical manifestations and digital subtraction angiography(DSA)results of patients with severe renal hemorrhage after PCNL and changes in the renal function after embolization,to evaluate the timing of DSA and the clinical efficacy and safety of super-selective renal artery coil embolization(SRAC E).Methods: In the first part retrospectively analyzed the data of all patients undergoing PCNL from January 01,2018,to October 31,2019,to investigate the predictive factors of severe hemorrhage after PCNL based on the amount of hemoglobin(Hb)loss.The second part retrospectively analyzed the clinical manifestations,hemorrhage characteristics,DSA manifestations and the results of renal function after embolization in all patients with severe renal hemorrhage after PCN L from March 01,2013,to March 31,2019,to evaluate the timing of DSA and the clinical efficacy and safety of SRACE.Results: The first part included a total of 505 patients(345 males and 160 females)in the target study population,with an average age of 48.3 ± 12.7 years old.Univariate studies found gender(male),affected kidney(left),Guy's scoring systems(GSS)grade IV,white blood cell(WBC)count,neutrophil count,and neutrophil percentage may be the predictive factors for severe hemorrhage after PCNL(P <0.05).After adjusting for demographic data,comorbidities,laboratory data,imaging data,and surgical data,we observed that gender(male),affected kidney(left),GSS grade IV,increased of neutrophil count and neutrophil percentage may be the predictive factors for severe hemorrhage after PCNL(P <0.05).In the second part,38 cases were included in the target study population,7 cases did not observe the exact hemorrhage point,31 cases of DSA showed renal arterial hemorrhage,of which 6 were arterial laceration,17 were pseudoaneurysm(PA),4 were arteriovenous fistula(AVF),and 4 were PA combined with AVF.According to the anatomical location of renal blood vessels,there are 4 were hemorrhaged from the upper pole of the renal artery,9 were hemorrhaged from the middle pole,and 18 were hemorrhaged from the lower pole.There were 2 cases of acute hemorrhage,of which 1 case had nephrectomy due to not effective control of hemorrhage after treatment with SRAC E combined with blood transfusion,20 cases were intermittent hemorrhage,16 cases were slow continuous hemorrhage.30 cases of the 31 patients were successfully embolized with a success rate of 96.8%.There were no significant differences in the estimated glomerular filtration ate(e GFR)(P=0.173),serum urea nitrogen(P=0.969),and serum creatinine(P=0.180)before and after SRACE(P>0.05).Conclusion: Gender(male),affected kidney(left),GSS grade IV,increased neutrophil count and neutrophil percentage may be the predictive factors for severe hemorrhage after PCNL.For those patients with increased neutrophil count and neutrophil percenta ge,removing inflammatory mediators or anti-infective treatment may be reduced hemorrhage after PCNL.Acute hemorrhage should be treated with DSA diagnosis and embolization as soon as possible.Intermittent and slow continuous hemorrhage is not effective with conservative treatment,DSA/SRACE can be used as the preferred method of examination and treatment.SRACE is a safe and effective treatment.