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目的总结微创经皮肾镜碎石取石术(mPCNL)术后严重出血的原因及其处理的经验。方法总结2000年12月至2011年12月1428例mPCNL患者的临床资料,共发生术后严重出血5例,男3例,女2例,平均年龄50岁。对出血原因及治疗结果进行分析。结果 mPCNL术后严重出血发生率为0.35%(5/1428),出血发生平均时间为术后4.2d,肾动脉造影显示4例为肾穿刺扩张通道小动脉损伤(动脉瘤形成),1例为动静脉瘘。5例患者经超选择性肾动脉栓塞治疗后,血尿消失。结论 mPCNL术后严重出血的原因大部分为穿刺通道的小动脉损伤,超选择性肾动脉栓塞有确切可靠的止血效果。
Objective To summarize the causes of severe postoperative bleeding after minimally invasive percutaneous nephrolithotomy (mPCNL) and its treatment experience. Methods The clinical data of 1428 patients with mPCNL from December 2000 to December 2011 were summarized. There were 5 cases of severe postoperative bleeding, 3 males and 2 females, with an average age of 50 years. Causes of bleeding and treatment results were analyzed. Results The incidence of severe postoperative bleeding was 0.35% (5/1428) in mPCNL patients and 4.2 days postoperatively. Renal angiography revealed 4 cases of small artery damage (aneurysm formation) with renal puncture dilatation channel and 1 case of Arteriovenous fistula. Hematuria disappeared in 5 patients after transselective renal artery embolization. Conclusion Most of the causes of severe postoperative bleeding in mPCNL are arteriolar lesion of the puncture channel. Superselective renal artery embolization has definite and reliable hemostatic effect.