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微创经皮肾镜取石术出血原因及防治 被引量:8

Prevention and cure of bleeding during mini-percutaneous nephrolithotripsy for calculi
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摘要 目的探讨微创经皮肾镜取石术(MPCNL)并发出血的原因及临床处理。方法对2006年6月~2009年6月期间治疗的1 367例MPCNL出血患者的临床资料进行回顾分析。结果术后血红蛋白下降值:〉60 g/L 16例(1.1%),30~60 g/L46例(3.4%),〈30 g/L1 306例(95.5%),平均9.9 g/L。术后血红蛋白下降值超过30 g/L的62例患者当中,经皮肾通道建立时出血者26例(41.9%),输尿管镜寻找结石或碎石时引起出血者13例(21%),感染和肾功能不全引起出血23例(37.1%),通过造瘘管压迫、输血等保守治疗55例,行肾切除止血1例,行超选择性栓塞止血6例,无死亡病例。结论 MPCNL出血的原因主要与建立经皮肾通道、术中不规范操作及患者有出血倾向等有关,选择合适手术时机,术中规范操作程序,准确判断出血的原因并及时治疗,可有效防治其出血的并发症。 Objective To discuss the cause and management of bleeding during mini-percutaneous nephrolithotomy(MPCNL) for calculi.Methods The clinical data of 1 367 bleeding case with calculi treated under MPCNL were analysed retrospectively.Results In 1 367 patients,16 cases hemoglobin drop exceeded 60 g/L,46 cases' drop was between 30~60 g/L,and 1 306 cases' drop was 30 g/L.The reasons of the 62 patients whose hemoglobin drop exceeded 30 g/L were diverse.26 patients were bleeding when the percuanteous approach was set up,13 when ureterosopic operation was performed.23 patients bled because of infection and renal inadequacy.17 patients were cured conservatively without secondary bleeding,six patients underwent angiography and subsequent hyperselective embolization,and 1 patient turned to nephrectomy.Conclusions The main causes of bleeding during MPCNL are the establishment of percutaneous passage,incorrect operational procedure and patients' hemorrhagic tendency.Suitable opportunity for operation,standardized operational procedure and promp management could lessen the complication of bleeding during MPCNL.
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出处 《现代泌尿外科杂志》 CAS 2011年第1期27-29,共3页 Journal of Modern Urology
关键词 微创经皮肾镜取石术 上尿路结石 出血 mini-percutaneous nephrolithotomy upper urinary tract calculi hemorrhage
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