经皮肾镜取石术后出血的介入治疗  

Interventional therapy of hemorrhage after percutaneous nephrolithotomy

作　　者：翟成喜[1] 李秋云 王彬 杨亚平[1] 陈戬[3] ZHAI Chengxi;LI Qiuyun;WANG Bin;YANG Yaping;CHEN Jian(Departments of Urinary Surgery,Yuxi People's Hospital/Sixth Affiliated Hospital of Kunming Medical University,Yuxi Yunnan 653100,China;Department of Anesthesia,Yuxi Traditional Chinese Medicine Hospital,Yuxi Yunnan 653100,China;Department of Urinary Surgery,Second Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650106,China)

机构地区：[1]玉溪市人民医院/昆明医科大学第六附属医院泌尿外科,云南玉溪653100 [2]玉溪市中医医院麻醉科,云南玉溪653100 [3]昆明医科大学第二附属医院泌尿外科,云南昆明650106

出　　处：《云南医药》2024年第4期32-36,共5页Medicine and Pharmacy of Yunnan

基　　金：云南省教育厅科学研究基金(2023J0307)。

摘　　要：目的研究PCNL术后出血患者接受选择性RAE治疗的效果及失败原因。方法对2015年4月-2023年5月期间本院20例PCNL术后出血患者以及外院转入的3例患者进行回顾性分析。结果DSA显示:PA 3人,AVF 6人,PA合并AVF 3人,动脉分支损伤8人,未见异常3人。所有23例PCNL术后出血患者行RAE治疗。其中,21例患者第一次RAE后成功止血,1例第一次RAE后再发出血行二次RAE成功,1例栓塞失败急诊行肾动脉分支结扎术止血成功。所有患者随访1月未发生再次出血。结论选择性RAE是治疗PCNL术后出血有效、安全的治疗方法,能最大程度保留患者肾功能。同时,治疗效果也与介入医师的操作技术密切相关。Objective To investigate the efficacy and failure reasons of selective RAE treatment in patients with postoperative hemorrhage after PCNL surgery.Methods From April 2015 to May 2023,20 patients with hemorrhage after PCNL surgery in our hospital and three patients transferred from other hospitals were retrospectively analyzed.Results DSA showed that there were three cases of PA,six cases of AVF,three cases of PA combined with AVF,eight cases of arterial branch injury,and no abnormalities found in three cases.All 23 patients with postoperative bleeding after PCNL underwent RAE treatment.Among them,21 patients were successfully hemostasis after the first RAE,one patient was successfully hemostasis after received second RAE,and one patient was successfully hemostasis after embolization and underwent emergency renal artery branch ligation.All patients were followed up for one month without any recurrence of bleeding.Conclusions Selective RAE is an effective and safe treatment for postoperative hemorrhage in PCNL,which can preserve renal function to the greatest extent for patients.At the same time,the therapeutic effect is closely related to the operational skill of the interventional physician.

关 键 词：经皮肾镜取石术 选择性肾动脉栓塞 出血 假性动脉瘤 动静脉瘘 

分 类 号：R699.2[医药卫生—泌尿科学]