经皮肾镜取石碎石术严重出血的处理策略

Treatment of Severe Hemorrhage in Percutaneous Nephrolithotomy

目的:分析应用经皮肾镜取石碎石术(PCNL)治疗上尿路结石发生严重出血的处理策略。方法:回顾性分析3184例行PCNL治疗上尿路结石患者资料,分析严重出血的处理策略。结果:3184例患者中,严重出血的74例(74/3184,2.3%),其中35例为术中出血,占(35/74,47.3%),39例为术后出血(39/74,52.7%)。52例(52/74,70.3%)经保守治疗治愈;19例(19/74,25.7%)介入栓塞治疗,其中,17例经1次介入栓塞治疗成功止血,1例经2次介入栓塞治疗成功止血,1例经2次介入栓塞治疗后仍有严重出血,改开放手术成功止血。3例直接开放手术成功止血。无肾切除。结论:PCNL术中术后出血是难以绝对避免的PCNL手术并发症,预防严重出血关键是规范手术操作。绝大多数患者经过保守治疗可控制出血,少部分患者需行选择性肾动脉栓塞术(SRAE)控制出血。把握介入治疗时机是止血成功的关键。

Objective:To analyze the treatment of severe bleeding during and after percutaneous nephrolithotomy(PCNL)for treating upper urinary tract calculi.Methods:The clinical data of 3184 patients with upper urinary calculi for PCNL were retrospectively analyzed,to summarize the treatment of severe bleeding.Results:A total of 3184patients were include in the study.Serious bleeding were found in 74(2.3%,74/3184)cases.35 cases bleeding occurred(47.3%)during operation and 39 cases(52.7%)after operation.52 cases(52/74,70.3%)were cured by conservative treatment;For 19(25.7%)cases treated with selective renal artery embolization,17 of them were cured with one operation,1 of them was cured with twice operations,but 1 case received twice selective renal artery embolization still re-bleeding,was converted to open operation.Open operation was performed for hemostasis in 3 cases directly.No kidney was removed.Conclusion:Bleeding during or after PCNL is the complication that can’t be absolutely prevented,Standardized surgical procedure is the key to prevention bleeding during PCNL.Most patients with severe bleeding after PCNL can be controlled by conservative treatment,only a small number of patients require selective renal artery embolization(SRAE)to control bleeding.Accurately grasping the timing of SRAE is the key to successful hemostasis.