微创经皮肾取石术严重出血原因分析及临床对策

Analysis of the causes of severe bleeding during or afterminimally invasive percutaneous nephrolithotomy and the clinical strategy

目的探讨微创经皮肾镜取石术并发严重出血的原因及防治措施。方法回顾性分析2005年1月至2010年1月收治53例微创经皮肾取石术严重出血的临床资料。结果出血原因为:穿刺不当出血6例,通道扩张出血15例,穿刺过深11例,碎石过程中集合系统裂伤出血15例,感染或败血症3例,肋间血管损伤1例,肾造瘘管脱出2例。51例经保守治疗全部治愈,2例行超选肾动脉介入栓塞治疗。无再次继发性出血,无死亡或者行肾切除病例。结论认识微创经皮肾取石术出血的各种原因,术中规范操作,术后仔细观察、准确判断出血原因及积极治疗,对微创经皮肾镜取石术严重出血的防治有重要意义。

Objective To discuss the cause and treatment of severe hemorrhage during or after minimally invasive percutaneous nephrolithotomy （MPCNL）. Methods 53 cases of severe hemorrhage during or after MPCNL from January 2005 to January 2010 were retrospectively analyzed. Results The causes of severe hemorrhage included inappropriate percutaneous puncture on 6 patients, tunnel expansion on 15 patients, excessive puncture on I1 patients, pierce and tear of the collective system on 15 patients, infestation and septicemia on 3 patients： injury of subcostal vessel on 1 patient; nepbostomy tube fell off on 2 patients. 51 patients were cured conservatively without secondary bleeding, 2 patients underwent angiography and subsequent hyperseleetive embolization. No patient imposed nephrectomy or die. Conclusions It is important to know every cause of MPCNL hemorrhage. Standardize the procedure during operation, accurate observation and perform hemostasis during or after operation for preventing the MPCNL hemorrhage.