微创经皮肾镜取石术后迟发出血原因及介入治疗

Analysis of the cause of hemorrhage after MPCNL and its interventional treatment

目的总结微创经皮肾镜取石术(MPCNL)术后迟发出血的原因及介入栓塞治疗的经验。方法回顾性分析1998年2月至2004年7月3812例MPCNL患者的临床资料,共发生术后迟发出血12例,男11例,女1例,平均年龄45岁。对出血原因及治疗结果进行分析。结果MPC- NL术后迟发出血发生率为0.31%(12/3812),迟发出血平均时间为术后10 d,肾动脉造影显示7例为肾穿刺扩张通道小动脉损伤(动脉瘤形成),5例为动静脉瘘。12例患者经超选择性肾动脉栓塞治疗后,血尿消失,随访肾功能恢复良好。结论MPCNL术后迟发出血发生率明显低于传统PCNL,出血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是控制出血的有效方法。

Objective To analyze the cause of delayed hemorrhage after minimally invasive percutaneous nephrolithotomy （ MPCNL）, and to summarize the experience in the interventional treatment of severe bleeding after MPCNL by superselective arteriolar embolization. Methods The clinical data of 3812 cases of MPCNL from June 1998 to July 2004 were reviewed. Of them,12 patients （11 men and 1 woman;mean age,45 years） who developed severe hemorrhage after MPCNL were identified. The cause of hemorrhage and the treatment results were analyzed. Results The rate of delayed hemorrhage after MPCNL was 0.31% （12/3812）. The mean time to onset of severe bleeding was 10 d after MPCNL. Renal arteriography was performed in all 12 patients,showing 5 arteriovenous fistulas and 7 false aneurysms. Superselective arteriolar embolization for hemostasis was performed in all 12 cases. All these vascular abnormalities were successfully treated by superselective embolization. Follow-up showed that the hematuria disappeared and renal function recovered well. Conclusions Severe hemorrhage following MPCNL is a rare complication, the incidence of which is significantly lower than that of conventional PCNL. The cause is mainly the arteriolar injury of renal puncture passage. Superselective embolization provides effective control of bleeding and currently constitutes the treatment of choice based on our experience.