CAJ | 학술논문

目的总结开放性肾部分切除手术后出血的危险因素及临床处理方法. 方法回顾性分析2008年5月至2011年10月362例行开放性肾部分切除术患者的资料,分析患者年龄、性别、体质指数、ASA评分、有无临床症状、高血压、糖尿病、冠心病/充血性心力衰竭、肿瘤良性和多发性及术前解剖影像分类系统(preoperative aspects and dimensions used for anatomical classification,PADUA)评分与术后出血的关系,并分析术后出血的临床处理方法. 结果 362例术后发生严重出血15例(4.1％).Logistic多因素回归分析结果显示,PADUA评分(P＜0.001)和多发肿瘤(P=0.004)是开放性保留肾单位手术出血发生的独立危险因素.15例患者中,保守治疗止血11例,行高选择性肾动脉栓塞4例,均顺利出院. 结论高PADUA评分和多发肿瘤是开放性肾部分切除手术出血的独立危险因素.高选择性肾动脉栓塞是肾部分切除术后出血安全有效的处理手段.
목적 총결개방성신부분절제수술후출혈적위험인소급림상처리방법. 방법 회고성분석2008년5월지2011년10월362례행개방성신부분절제술환자적자료,분석환자년령、성별、체질지수、ASA평분、유무림상증상、고혈압、당뇨병、관심병/충혈성심력쇠갈、종류량성화다발성급술전해부영상분류계통(preoperative aspects and dimensions used for anatomical classification,PADUA)평분여술후출혈적관계,병분석술후출혈적림상처리방법. 결과 362례술후발생엄중출혈15례(4.1％).Logistic다인소회귀분석결과현시,PADUA평분(P＜0.001)화다발종류(P=0.004)시개방성보류신단위수술출혈발생적독립위험인소.15례환자중,보수치료지혈11례,행고선택성신동맥전새4례,균순리출원. 결론 고PADUA평분화다발종류시개방성신부분절제수술출혈적독립위험인소.고선택성신동맥전새시신부분절제술후출혈안전유효적처리수단.
Objective To identify the risk factors for hemorrhage after open partial nephrectomy (OPN) for renal tumor,and to discuss the clinical management.Methods From May 2008 to October 2011,362 consecutive patients who underwent OPN in Renji Hospital were analyzed in this study.Sex,age,body mass index,ASA score,hypertension,diabetes mellitus,coronary artery disease/congestive heart failure,multifocality,malignant vs benign pathology and preoperative aspects and dimensions used for anatomical classification (PADUA) score were tested and significant variables entered in a multivariate model associated with hemorrhagic complications (blood loss requiring blood transfusion).The clinical management of hemorrhage after OPN was reviewed.Results Fifteen patients with bleeding received blood transfusion in the 362 cases.On muhivariate analysis,PADUA score (P＜0.001) and multifocal tumors (P=0.004) were independent risk factors associated with hemorrhagic complications.Among 15 bleeding patients,11 received conservative therapy; other 4 needed superselective percutaneous transarterial embolization (TAE).Bleeding was finally controlled in all the 15 patients.Conclusions High PADUA score and multifocal tumors could be identified as risk factors for hemorrhage after OPN.The management was relying on TAE as an effective and safe treatment for bleeding after OPN.