逆行肾内输尿管软镜手术后迟发性肾包膜下血肿二例  

Delayed renal subcapsular hematoma after retrograde intrarenal surgery:a two-cases report and literature review

作　　者：韩孝洲 刘剑新 张勇 邱瑾 田长海 刘旺 胡华军 HAN Xiaozhou;LIU Jianxin;ZHANG Yong(Department of Urology,Shanghai TCM-integrated Hospital,Shanghai University of TCM,Shanghai 200082,China)

机构地区：[1]上海中医药大学附属上海市中西医结合医院泌尿外科,200082 [2]上海中医药大学附属上海市中西医结合医院肾内科,200082

出　　处：《临床外科杂志》2023年第2期147-150,共4页Journal of Clinical Surgery

基　　金：上海市卫生健康委员会卫生行业临床研究专项(No:201940426);上海市虹口区卫生健康委员会医学科研专项(No:虹卫2102-03)。

摘　　要：目的总结逆行肾内输尿管软镜手术(RIRS)治疗肾结石发生迟发性肾包膜下血肿(DRSH)的诊断和治疗体会。方法分析2例因肾结石行RIRS后发生DRSH的病例资料,评估术前一般情况、手术和DRSH的诊断和治疗。结果2例RIRS手术均顺利,手术时间分别为55分钟和38分钟,术后均留置F6双J管,术后止血及抗感染治疗,复查泌尿系超声或CT未见异常,术后2~4周后拔除双J管。1例术后1个月余、1例术后2周余出现DRSH,给予止血、抗感染治疗,2例血肿分别于保守治疗1个月余和5个月余后吸收。结论RIRS治疗肾结石可发生DRSH。合并高血压或糖尿病等基础疾病、高龄以及使用抗凝药物等或为导致DRSH产生的部分因素。对于肾包膜完整、无合并感染的DRSH,经止血、抗感染等保守治疗血肿可以逐渐吸收。Objective To explore the diagnosis and treatment of delayed renal subcapsular hematoma(DRSH)after retrograde intrarenal surgery(RIRS)for renal calculi and related factors.Methods Case data of 2 patients with DRSH after RIRS were retrospectively analyzed.The preoperative general situation,operative situation,diagnosis and treatment of subcapsular hematoma were evaluated.Results RIRS were performed successfully in 2 cases with renal calculi and the operation time were 55 min and 38 min respectively.Both patients were indwelled with F6 ureteral double J stent.Postoperative hemostasis and antibiotics were used.Postoperative re-examination of urinary ultrasound or CT showed no abnormalities and the patients were discharged,and the double J stent were removed 4 weeks and 2 weeks after operation respectively.One case developed DRSH more than 1 month after operation and the other one more than 2 weeks after operation.After hemostasis and anti-infection treatment,the hematoma in 2 cases were absorbed within more than 1 month and more than 5 months respectively.Conclusion DRSH may occur in the treatment of renal calculi by RIRS.The combination of basic diseases such as hypertension or diabetes,old age,the use of anticoagulant drugs may be some of the factors leading to DRSH.For patients with complete renal capsule and no combined infection,conservative treatment such as hemostasis and anti-infection should be given,and the hematoma can be gradually absorbed.

关 键 词：逆行肾内输尿管软镜手术 肾包膜下血肿 病例分析 

分 类 号：R699[医药卫生—泌尿科学]