经皮肾镜取石术患者大出血的原因及其治疗对策探讨  

Cause and therapeutic countermeasures of haemorrhage in patients undergoing percutaneous nephrolithotomy

作　　者：霍伟棠[1] 罗丽[1] 肖龙明[1] 

机构地区：[1]玉林市第二人民医院泌尿外科,广西玉林537000

出　　处：《海南医学》2013年第14期2115-2117,共3页Hainan Medical Journal

摘　　要：目的总结经皮肾镜取石术中术后出血的原因及其防治经验。方法对我院2005-2012年间行微创经皮肾镜取石术时出现术中或术后大出血的56例患者做回顾性分析。结果分析发现经皮肾穿刺过程中出现大出血5例,肾穿刺后瘘道扩张时引起大出血14例,术中碎石、取石过程大出血19例,术后迟发性大出血18例。出血原因与操作不当、技术欠熟练、存在尿路感染、手术设备等因素有较大关联。本组出血病例发生在手术开展早期(2005-2008年)为39例,占70%,通过采用各种预防方法后(2009-2012年)为19例,约为30%。大出血后针对不同情况采用保守治疗、动脉介入栓塞止血、开放手术止血等方法可获良好治疗效果。结论了解经皮肾镜取石出血的原因,加强预防措施可减少大出血的发生率,针对不同的出血情况采取不同治疗方式,可获良好治疗效果,有利于微创经皮肾镜取石术的进一步开展。Objective To analyze the causes of intraoperative and postoperative haemorrhage in the percuta- neous nephrolithotomy （PCNL）, and to summarize the prevention and treatment experience. Methods The clinical da- m of 56 patients who suffered intraoperative or postoperative haemorrhage during minimally invasive PCNL in our hospital from 2005 to 2012 were retrospectively analyzed. Resdts Five patients suffered hemorrhage in the process of pereutaneous renal puncture, 14 suffered hemorrhage in the expansion of fistula after renal biopsy, 19 suffered hem- orrhage in lithotripsy, and 18 occurred tardive_hemorrhea after operation. Hemorrhage has great relevance with, for in- stance, improper operation, less skilled technology, urinary tract infection, surgical equipment. There were 39 cases of hemorrhage which occurred in the early stage of operation （2005-2008）, accounting for 70%. After the application of various preventive measures, the cases of hemorrhage reduced to 19 （2009--2012）, occupying 30%. Using conservative treatment, artery interventional embolization, open surgery can ensure the satisfactory therapeutic effects for hemosta- sis. Conclusion Understanding the causes of hemorrhage in pereutaneous nephrolithotomy, strengthening preventive measures to reduce the incidence of massive hemorrhage, and applying individual treatments for different bleeding to- gether helps promote the further development of minimally invasive pereutaneous nephrolithotomy.

关 键 词：经皮肾镜取石 大出血 原因 

分 类 号：R699[医药卫生—泌尿科学]