经皮肾镜碎石术(PCNL)后迟发性出血的原因及介入治疗

Analysis of causes and interventional therapy of delayed hemorrhage after percutanous nephrolithotomy(PCNL)

目的总结经皮肾镜碎石术(percutanous nephrolithotomy,PCNL)后迟发性出血的诊疗经验。方法我院2006至2010年间使用PCNL治疗了1 036例上尿路结石患者,术后出现迟发性出血7例,收治外院行PC-NL术后的迟发性出血患者4例,共计11例:男9例,女2例。年龄48～75岁,平均59.8岁。肾多发性结石6例,肾铸型结石3例,孤立肾结石1例,输尿管上段结石1例。结合临床资料分析迟发性出血的临床表现、原因及介入治疗经验。结果 11例患者经超选择性肾动脉栓塞辅以保守治疗后血尿消失,血常规及肝肾功能指标逐渐恢复正常。数字减影血管造影(digital subtraction angiography,DSA)结果示:假性动脉瘤10例,其中下极动脉分支假性动脉瘤7例,中极动脉分支假性动脉瘤2例,中极及下极兼有者1例;下极动静脉瘘1例。结论术中操作损伤导致的假性动脉瘤及动静脉瘘是迟发性出血的原因;超选择性肾动脉栓塞是治疗PCNL术后迟发性出血安全有效的手段。

Objective To conclude experience in diagnosis and treatment of delayed hemorrhage. Methods During 2006 to 2010,1036 patients received percutanous nephrolithotomy（PCNL） in our hospital and delayed hemorrhage occurred in 7 of them;4 patients with delayed hemorrhage,who received PCNL in other hospitals,were also treated by us.The 11 cases were 9 males and 2 females,aged 48 to 75,and 59.8 in average.There were 6 cases of multiple stones in kidney,3 cases of mold stones and 1 case of stones in solitary kidney,1 case of upper ureteral stone.Clinical presentations,causes and interventional therapy of delayed hemorrhage after PCNL were analysed according to these cases. Results After hyperselective renal arteriolar embolizaion and conservative therapy,hematuria disappeared and blood routine,liver function and renal function gradually returned to normal.Digital subtraction angiography（DSA） results showed 10 cases of false aneurysms：7 of 10 were on lower pole arterial branch,2 were on middle pole arterial branch,1 was on both lower pole arterial branch and middle pole aterial branch;and 1 case of arteriovenous fistula in lower pole. Conclusions False aneurysm and arteriovenous fistula caused by injuries of kidney in PCNL may lead to delayed hemorrhage.Hyperselective renal arteriolar embolizaion is an effecive and safe way to cure delayed hemorrhage after PCNL.