{"title":"经皮肾镜取石术出血风险的预测因素","authors":"U Phun Loo, Chun Hou Yong, Guan Chou Teh","doi":"10.1016/j.ajur.2022.02.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to identify predictive factors for percutaneous nephrolithotomy (PCNL) bleeding risks. With better risk stratification, bleeding in high-risk patient can be anticipated and facilitates early identification.</p></div><div><h3>Methods</h3><p>A prospective observational study of PCNL performed at our institution was done. All adults with radio-opaque renal stones planned for PCNL were included except those with coagulopathy, planned for additional procedures. Factors including gender, co-morbidities, body mass index, stone burden, puncture site, tract dilatation size, operative position, surgeon's seniority, and operative duration were studied using stepwise multivariate regression analysis to identify the predictive factors associated with higher estimated hemoglobin (Hb) deficiency.</p></div><div><h3>Results</h3><p>Overall, 4.86% patients (<em>n</em>=7) received packed cells transfusion. The mean estimated Hb deficiency was 1.3 (range 0–6.5) g/dL and the median was 1.0 g/dL. Stepwise multivariate regression analysis revealed that absence of hypertension (<em>p</em>=0.024), puncture site (<em>p</em>=0.027), and operative duration (<em>p</em>=0.023) were significantly associated with higher estimated Hb deficiency. However, the effect sizes are rather small with partial eta-squared of 0.037, 0.066, and 0.038, respectively. Observed power obtained was 0.621, 0.722, and 0.625, respectively. Other factors studied did not correlate with Hb difference.</p></div><div><h3>Conclusion</h3><p>Hypertension, puncture site, and operative duration have significant impact on estimated Hb deficiency during PCNL. However, the effect size is rather small despite adequate study power obtained. Nonetheless, operative position (supine or prone), puncture number, or tract dilatation size did not correlate with Hb difference. The mainstay of reducing bleeding in PCNL is still meticulous operative technique. Our study findings also suggest that PCNL can be safely done by urology trainees under supervision in suitably selected patient, without increasing risk of bleeding.</p></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"11 1","pages":"Pages 105-109"},"PeriodicalIF":2.4000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214388222000042/pdfft?md5=f69635eed4ce7855ab94312efa88b599&pid=1-s2.0-S2214388222000042-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Predictive factors for percutaneous nephrolithotomy bleeding risks\",\"authors\":\"U Phun Loo, Chun Hou Yong, Guan Chou Teh\",\"doi\":\"10.1016/j.ajur.2022.02.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>This study aimed to identify predictive factors for percutaneous nephrolithotomy (PCNL) bleeding risks. With better risk stratification, bleeding in high-risk patient can be anticipated and facilitates early identification.</p></div><div><h3>Methods</h3><p>A prospective observational study of PCNL performed at our institution was done. All adults with radio-opaque renal stones planned for PCNL were included except those with coagulopathy, planned for additional procedures. Factors including gender, co-morbidities, body mass index, stone burden, puncture site, tract dilatation size, operative position, surgeon's seniority, and operative duration were studied using stepwise multivariate regression analysis to identify the predictive factors associated with higher estimated hemoglobin (Hb) deficiency.</p></div><div><h3>Results</h3><p>Overall, 4.86% patients (<em>n</em>=7) received packed cells transfusion. The mean estimated Hb deficiency was 1.3 (range 0–6.5) g/dL and the median was 1.0 g/dL. Stepwise multivariate regression analysis revealed that absence of hypertension (<em>p</em>=0.024), puncture site (<em>p</em>=0.027), and operative duration (<em>p</em>=0.023) were significantly associated with higher estimated Hb deficiency. However, the effect sizes are rather small with partial eta-squared of 0.037, 0.066, and 0.038, respectively. Observed power obtained was 0.621, 0.722, and 0.625, respectively. Other factors studied did not correlate with Hb difference.</p></div><div><h3>Conclusion</h3><p>Hypertension, puncture site, and operative duration have significant impact on estimated Hb deficiency during PCNL. However, the effect size is rather small despite adequate study power obtained. Nonetheless, operative position (supine or prone), puncture number, or tract dilatation size did not correlate with Hb difference. The mainstay of reducing bleeding in PCNL is still meticulous operative technique. Our study findings also suggest that PCNL can be safely done by urology trainees under supervision in suitably selected patient, without increasing risk of bleeding.</p></div>\",\"PeriodicalId\":46599,\"journal\":{\"name\":\"Asian Journal of Urology\",\"volume\":\"11 1\",\"pages\":\"Pages 105-109\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2214388222000042/pdfft?md5=f69635eed4ce7855ab94312efa88b599&pid=1-s2.0-S2214388222000042-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Journal of Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2214388222000042\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2214388222000042","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Predictive factors for percutaneous nephrolithotomy bleeding risks
Objective
This study aimed to identify predictive factors for percutaneous nephrolithotomy (PCNL) bleeding risks. With better risk stratification, bleeding in high-risk patient can be anticipated and facilitates early identification.
Methods
A prospective observational study of PCNL performed at our institution was done. All adults with radio-opaque renal stones planned for PCNL were included except those with coagulopathy, planned for additional procedures. Factors including gender, co-morbidities, body mass index, stone burden, puncture site, tract dilatation size, operative position, surgeon's seniority, and operative duration were studied using stepwise multivariate regression analysis to identify the predictive factors associated with higher estimated hemoglobin (Hb) deficiency.
Results
Overall, 4.86% patients (n=7) received packed cells transfusion. The mean estimated Hb deficiency was 1.3 (range 0–6.5) g/dL and the median was 1.0 g/dL. Stepwise multivariate regression analysis revealed that absence of hypertension (p=0.024), puncture site (p=0.027), and operative duration (p=0.023) were significantly associated with higher estimated Hb deficiency. However, the effect sizes are rather small with partial eta-squared of 0.037, 0.066, and 0.038, respectively. Observed power obtained was 0.621, 0.722, and 0.625, respectively. Other factors studied did not correlate with Hb difference.
Conclusion
Hypertension, puncture site, and operative duration have significant impact on estimated Hb deficiency during PCNL. However, the effect size is rather small despite adequate study power obtained. Nonetheless, operative position (supine or prone), puncture number, or tract dilatation size did not correlate with Hb difference. The mainstay of reducing bleeding in PCNL is still meticulous operative technique. Our study findings also suggest that PCNL can be safely done by urology trainees under supervision in suitably selected patient, without increasing risk of bleeding.
期刊介绍：
Asian Journal of Urology (AJUR), launched in October 2014, is an international peer-reviewed Open Access journal jointly founded by Shanghai Association for Science and Technology (SAST) and Second Military Medical University (SMMU). AJUR aims to build a communication platform for international researchers to effectively share scholarly achievements. It focuses on all specialties of urology both scientifically and clinically, with article types widely covering editorials, opinions, perspectives, reviews and mini-reviews, original articles, cases reports, rapid communications, and letters, etc. Fields of particular interest to the journal including, but not limited to: • Surgical oncology • Endourology • Calculi • Female urology • Erectile dysfunction • Infertility • Pediatric urology • Renal transplantation • Reconstructive surgery • Radiology • Pathology • Neurourology.
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