经皮肾穿刺通道处理在预防PCNL术后出血中的应用

The value of the percutaneous nephrostomy channel processing in the prevention of bleeds after PCNL

目的探讨经皮肾镜取石术后通道出血的预防处理方案及肾造瘘管夹闭时间。方法回顾分析2011年1月~2013年12月由同一名泌尿外科医生完成386例经皮肾镜取石术,随机分2组,对照组190例,通道未经处理,术后夹管2 h。观察组196例,手术结束时常规检查通道,见明显活动性出血予电灼止血,术后视引流情况夹管时间0~48 h;比较两组病例术后出血及血色素下降情况的差异。结果对照组术后大出血3例,经超选择性肾动脉栓塞止血治愈,血色素下降0.1~6.0 g,平均1.8 g;观察组未出现大出血,血色素下降0.1~1.8 g,平均0.8 g。两组血色素下降比较差异有统计学意义（P〈0.05）。结论 PCNL术手术结束时应常规检查通道,就像其他手术检查创面一样,必要时电灼止血,操作简单、方便。

Objective To explore the channel of hemorrhage after percutaneous nephrolithotomy postoperativerenal fistula prevention and treatment scheme and clamping time. Methods A retrospective analysis of 2011.01 - 2013.12 by the same urologistperformed. 386 cases of percutaneous nephrolithotomy were randomly divided into 2 groups.The control group of 190 cases, the channel of untreated, pinch 2 h after operation.The experimental group of 196 cases, routine examination of channel at the end of the operation, obvious active bleeding by electroeoagulation.After drainage pipe clamping time 0 ~ 48 h;The difference of reduced bleeding and hemoglobinwere compsred in the two groups M＇ter operation. Results 3 patients in the former group with severe hemorrhage after surgery were cured by the snperselective renal artery embolization with the hemochrome declining 0.1 to 6.0g, and the mean 1.Sg. In the group 2, no cases appeared severe hemorrhage with the hemochrome declining 0.1 to 1.8 g, and the mean 0.8 g. The decline of hemochrome in two groups was significant. Conclusion Routinely examining channel when the surgery finished is required and the electrocautery is needed when the obvious active bleeding occurred. And the time of renal made fistula clipped was decided according to the condition of drainage after surgery.