微创经皮肾镜取石术大出血原因分析及处理  

Cause and management of hemorrhage after minimally invasive percutaneous nephrolithotomy

作　　者：陈仪[1] 王国成[1] 徐小军[1] 印利明[1] 吴健[1] 甘卫东[2] 

机构地区：[1]江苏省泰兴市人民医院泌尿外科,225400 [2]南京大学医学院附属鼓楼医院泌尿外科,南京210008

出　　处：《中华腔镜泌尿外科杂志（电子版）》2011年第6期14-16,共3页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的分析微创经皮肾镜取石术（MPCNL）术后大出血原因,总结超选择性肾动脉栓塞治疗的经验和疗效,提高经皮肾镜术后出血的处理水平。方法回顾性分析2008年1月至2011年4月MPCNL术中、术后出血〉600ml的10例患者的临床资料。男4例,女6例;年龄48~71岁,平均42岁;2例为输尿管上段结石,8例为肾脏结石。结果术中明显出血2例患者中,1例压迫止血无效,大出血转行开放手术,缝扎造瘘口2针止血,另1例放置造瘘管压迫止血,改行二期MPCNL。术后出血8例,3例经夹闭造瘘管、卧床休息、使用止血药后出血停止;5例迟发性出血经超选择性肾动脉栓塞出血血管,出血停止。随访发现患肾功能均恢复正常。结论大出血是MPCNL的一种严重并发症,动脉造影和超选择性动脉栓塞是安全可靠的止血方法。Objective To explore the cause and management of hemorrhage after mini-really invasive pereutaneous nephrolithotomy（PCNL） and to introduce the experience of super selective renal arterial embolization in order to improve the management. Methods From January 2008 to April 2009, there were 10 patients （4 men and 6 women）, whose mean age was 42 years （48-71） developed severe bleeding following PCNL. Two patients got upper ureteral stones, eight patients got kidney stones. The cause of hemorrhage and treatments were retrospectively analyzed and summarized. Results Intraoperative bleeding occurred in two patients, one was converted to open surgery, the other was controlled by nephrostomy tube compression and waited the second PCNL. Postoperative bleeding occurred in eight patients, three of eight received conservative treatment effectively, the other five patients with delayed hemorrhage underwent super-selective arteriolar embolization successfully. The intravenous pyelogram revealed the renal function kept well during follow-up visit. Conclusions Massive hemorrhage is one of the severe complications. The renal arteriography and super-selective arteriolar embolization could be a safe and effective treatment for the severe hemorrhage after PCNL.

关 键 词：微创经皮肾镜取石术 出血 动脉造影 栓塞 

分 类 号：R699[医药卫生—泌尿科学]