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目的分析经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)出血并发症急诊处理的治疗效果。方法回顾性分析经皮肾镜碎石取石术治疗上尿路复杂性结石3286例的临床资料。结果该组3286例患者,27例并发明显出血(0.82%)。出血原因主要为穿刺道选择不理想,有17例(62.96%)。术中出血13例,术后出血14例,反复迟发性出血3例;全组输血共7例,占25.93%(7/27);无中转开放手术及行肾切除病例;24例经局部压迫、输血、抗炎、利尿、止血、绝对卧床休息等治疗痊愈,3例急诊行超选择肾动脉栓塞术治愈。结论经皮肾镜碎石取石术出血是一种少见且难以预测的并发症,可危及生命需急诊处理,准确判断出血的原因并掌握术中预防出血的操作方法可使其并发症风险明显降低。术后反复出血首先应考虑肾迟发性出血的可能,急诊行超选择性肾动脉栓塞术是解决此类出血并发症安全、有效的方法。
Objective To analyze the curative effect of emergency treatment of bleeding complications of percutaneous nephrolithotomy (PCNL). Methods The clinical data of 3286 cases of complicated upper urinary tract stones treated with percutaneous nephrolithotomy were retrospectively analyzed. Results The group of 3286 patients, 27 cases of complicated bleeding (0.82%). The main causes of bleeding were poor choice of puncture, there are 17 cases (62.96%). Intraoperative bleeding in 13 cases, postoperative bleeding in 14 cases, repeated delayed bleeding in 3 cases; the whole group of blood transfusions in 7 cases, accounting for 25.93% (7/27); no transfer of open surgery and nephrectomy cases; 24 cases of local Oppression, blood transfusion, anti-inflammatory, diuretic, hemostasis, absolute bed rest and other treatment were cured, 3 cases of emergency treatment of super-selective renal artery embolization were cured. Conclusion Percutaneous nephrolithotripsy is a rare and unpredictable complication, which can endanger the lives of emergency treatment, accurately determine the cause of bleeding and operation to prevent intraoperative bleeding can significantly reduce the risk of complications . Repeated bleeding after surgery should consider the possibility of delayed hemorrhage, emergency line of ultra-selective renal artery embolization is to solve such complications of bleeding safe and effective method.