微创经皮肾镜碎石术并发大出血原因及临床处理分析

Analysis of causes of massive hemorrhage following MPCNL and clinical treatment

目的分析微创经皮肾镜碎石取石术(minimally invasive percutaneous nephrlithotomy,MPCNL)大出血的原因,并探讨出血的预防与控制及介入栓塞术止血的效果及相关经验。方法回顾性分析该院2004年10月～2008年6月10例MPCNL大出血患者的临床资料,其中男性9例,女性1例,年龄36～73岁,平均50岁。对出血原因,出血的预防与控制及介入栓塞止血治疗的效果进行分析和探讨。结果MPCNL术并发出血10例,其中术中出血2例,术后出血8例,术中出血多为建立穿刺通道时以及进入集合系统后碎石时血管或肾实质损伤引起,术后出血多为假性动脉瘤、动静脉瘘形成等。10例出血患者均行了介入栓塞治疗,止血效果好,术后血压、血常规及肾功能情况恢复好。结论超选择肾动脉介入栓塞技术治疗MPCNL并发的严重出血是安全有效的,而且能很大程度上保留肾组织和保护肾功能。

[Objective] To analyze the cause of massive hemorrhage following minimally invasive percutaneous nephrolithotomy （MPCNL）, to summarize the experience in the interventional treatment of severe bleeding after MPCNL by super-selective arteriolar embolization. [Methods] From Oct 2004 to Jun 2008, 10 cases （9 men and 1 woman, mean age 50 years） who developed severe bleeding following MPCNL were identified, the cause, prevention and treatment of the hemorrhage were analyzed. [Results] In the 10 patients who had severe bleeding following MPCNL 2 cases had hemorrhage during MPCNL, 8 after MPCNL. The intra-operative bleeding was mainly caused by injury of arteries and renal parenchyma when the renal puncture passage was established, and the causes of post-operative hemorrhage were false aneurysm and arteriovenous fistula. All these bleeding patients were successfully treated by the super-selective arteriolar embolization. And the BR, BP, renal functions recovered well. [ Conclusion ] The super-selective arteriolar embolization for the treatment of the severe hemorrhage following MPCNL is safe and effective, and could protect the renal functions well.