PCNL术后迟发性大出血影响的因素分析及治疗(附6例报道)

Evaluation of Factors Affecting Massive Delayed Hemorrhage after Percutaneous Nephrolithotomy and Treatment for this Complication(Report of 6 Cases)

目的探讨PCNL术后迟发性大出血的影响因素和处理方法。方法一组364例行PCNL手术的患者中,有6例在术后3-7 d出现迟发性大出血。男4例,女2例,肾脏多发性结石4例,输尿管上段结石2例,回顾性分析迟发性出血的临床表现、影响因素及治疗经验。结果数字减影血管造影（digital subtraction angiography,DSA）结果示：4例为假性动脉瘤,1例为假性动脉瘤合并动静脉瘘。保守治疗1例,介入栓塞治疗5例,1例行2次介入栓塞治疗。结论 PCNL术后迟发性大出血比较少见,难以预料。往往与穿刺通道有关。保守治疗无效时,应该及时采用选择性动脉栓塞术治疗。

Objectives To evaluate the affecting factors of massive delayed hemorrhage after petcutaneous nephrolithotomy （PCNL） and the management to deal with this complication. Methods From 2009 to 2014,364 patients had underwent PCNL for upper urinary calculi, massive delayed hemorrhage occurred in 6 of them, 4 males and 2 females, Clinical manifestation, Affecting factors and treatment experience of massive delayed hemorrhage after PCNL were retrospectively analysised according to these cases. Results The results of digital subtraction angiography showed that renal pseudoaneurysm （RAP） in 4 cases, RAP combined with renal arteriovenous fistula （RAVF） in 1 case. 1 case were successfully managed with conservative treatment and the hematuria resolved. 5 cases were treated with selective renal arterial embolization, with complete resolution of haemorrhage, no fitrther clinical deterioration, and preservation of renal functionl of the 5 cases underwent repeat angiography and embolization of the lesion. Conelustons Massive delayed hemorrhage after PCNL is a rare and unpredictable complication of percutaneous nephrolithotripsy,this complication is generally associated with the nephrostomy tract,when conservative treatment is inefficacy, selective renal arterial embolization should be performed timely.