经皮肾穿刺造瘘术治疗Ⅳ度出血性膀胱炎2例  

Percutaneous nephrostomy for stageⅣhemorrhagic cystitis:Two case reports

作　　者：吉奇 李泊涵 吴晓晨 杨晨唯 吴水燕[1] 张永平 胡绍燕[1] JI Qi;LI Bohan;WU Xiaochen;YANG Chenwei;WU Shuiyan;ZHANG Yongping;HU Shaoyan(Children′s Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属儿童医院血液科,苏州215000

出　　处：《中国小儿血液与肿瘤杂志》2023年第2期103-106,共4页Journal of China Pediatric Blood and Cancer

基　　金：国家自然科学基金(81970163);苏州大学第二十四批大学生课外学术科研基金(KY20221096B)。

摘　　要：目的本研究探讨经皮肾穿刺造瘘术(PCN)治疗异基因造血干细胞移植(allo-HSCT)后重度出血性膀胱炎(HC)的可行性及有效性。方法分析2例急性白血病患儿行allo-HSCT后发生IV度出血性膀胱炎,巨大血凝块导致肾后性梗阻,膀胱造瘘及介入栓塞术无效,给予PCN治疗患儿的临床转归,并复习相关文献。结果病例1为9岁7个月男性患儿,因高危急性淋巴细胞白血病接受allo-HSCT,移植后+61d出现膀胱内巨大血凝块充填,行经皮膀胱穿刺造瘘术后无效,次日行B超引导下经皮双侧PCN,肾后性梗阻解除,HC好转且膀胱功能恢复;病例2为9岁7个月男性allo-HSCT后Ⅳ度HC患儿,移植后+91d出现血凝块致上尿路梗阻,当日行双侧髂内动脉分支介入栓塞术,效果不佳,+93d行PCN,术后梗阻解除,但因患儿持续骨髓植入功能不良,家属放弃治疗。结论经皮肾穿刺造瘘术(PCN)是治疗重度HC的一种相对安全、有效的介入方式,值得积累更多的病例。Objective To investigate the feasibility and effectiveness of percutaneous nephrostomy(PCN)in the treatment of severe hemorrhagic cystitis(HC)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Clinical outcomes of 2 acute leukemia children suffered from stageⅣhemorrhagic cystitis after allo-HSCT were analyzed.Because huge blood clots caused posterior renal obstruction,they received a cystostomy and interventional embolization but neither were successful.Ultimately it was resolved by PCN.Related literatures were reviewed.Results Case 1 was a 9-year and 7-month old boy with high-risk acute lymphoblastic leukemia and received allo-HSCT.After transplantation,a huge blood clot filled the bladder at+61d,and the percutaneous cystostomy was ineffective.PCN was performed under the guidance of B-ultrasound the next day,and then the retrorenal obstruction was relieved,with HC improved and bladder function recovered.Case 2 was a 9-year and 7-month old boy with stage IV HC after allo-HSCT.After transplantation,a blood clot caused upper urinary tract obstruction at+91d.On the same day,interventional embolization of bilateral internal iliac artery branches was performed,and the effect was not good.PCN was performed at+93d,and the postoperative obstruction was relieved.However,due to the persistent bone marrow implantation dysfunction of the child,the family members gave up treatment.Conclusions Percutaneous nephrostomy(PCN)is a relatively safe and effective interventional method for the treatment of severe HC,and it is worth accumulating more cases.

关 键 词：造血干细胞移植 儿童 出血性膀胱炎 经皮肾穿刺造瘘 

分 类 号：R726.9[医药卫生—儿科] R733.71[医药卫生—临床医学]