输尿管镜取石术肾脏大出血的原因分析  

Percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors

作　　者：刘星明[1] 任胜强[1] 王强辉[1] 梁宇[1] 徐立奇[1] 

机构地区：[1]中国人民解放军第113医院泌尿外科,浙江宁波315040

出　　处：《中华腔镜泌尿外科杂志（电子版）》2015年第5期28-30,共3页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的分析输尿管镜取石术肾脏大出血的原因。方法回顾分析自2010年3月至2013年6月10例因输尿管结石行输尿管镜取石术肾脏大出血患者的临床资料。结果4例术中明显出血，1例止血成功，3例尿色鲜红视野不清而终止手术，置入输尿管双J管引流，术后肾脏CT报告肾盂血块、肾包膜下血肿，经保守治疗后病情好转，其中1例输血600ml。3例术后16～24h下床活动后严重血尿，保守治疗无效，肾脏CT报告肾脏血肿（或肾包膜下血肿）、输尿管双J管穿入肾实质，2例在膀胱镜下调整双J管位置正常后血尿停止，1例行高选择性肾动脉分支栓塞治疗后痊愈。3例术后第3天肾脏CT报告。肾包膜下血肿，1例肾脏大出血保守治疗6d后无效行患肾切除术。2例手术顺利，术中术后无明显肉眼血尿。均随访6～12个月，血肿逐渐吸收缩小，肾功能正常，未再出现肾脏出血。结论术前控制感染、术中保持低压灌注并直视下留置双J管恰当位置是防止肾脏大出血的关键。ObijectiveTo analyze the causes and prevention of renal hemorrhage alterureterolithotripsy.methods The data of 10 cases suffering from renal hemorrhage during ureterolithotripsyfrom March 2010 to June 2013 in the 113rd Hospital of People＇s Liberation Army were analyzed.Resuit Obvious hemorrhage was observed in 4 patients during the operations, bleeding stanched in 1 patient, the other 3 operations were failed, then ureteral double-j tubes were placed for drainage,and they recovered after conservative treatment. 3 cases were found hemorrhage 16-24 hours after oprations. CT showed renal hemotoma and ureteral double-J tube penetrating renal parenchyma. 2 patients were cured by adjusting the position of double J tube by cystoscope and 1 underwent selective renal arterial embolization. 3 patients were found renal subcapsular hematoma by CT 3 days after operations. 1 case was not cured conservatively and underwent nephrectomy. 2 patients had no obvious hematuria postoperatively.All the patients were followed 6to12 months, the hematoma absorbed completely and kidney bleeding did not recurred.Conclusiontube in the correct position are the keys to prevent renal hemorrhage.

关 键 词：输尿管镜 输尿管结石 出血 

分 类 号：R699[医药卫生—泌尿科学]