经皮肾穿刺通道处理在预防经皮肾镜取石术术后出血中的应用

Value of percutaneous nephrostomy channel processing in prevention of bleeding after PCNL

目的 探讨经皮肾镜取石术（PCNL）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,并随机分为两组,前组190例,通道未经处理,术后夹管2 h。后组196例,手术结束时常规检查通道,见明显活动性岀血予电灼止血（附止血过程录像）,术后视引流情况夹管时间0~48 h;比较两组病例术后岀血及血色素下降情况的差异。结果前组术后大出血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;后组未出现大出血,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〈0.01）。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。据引流情况决定造瘘管夹闭时间。

[ Objective ] To explore the prevention and the treatment measures of the channel bleeding after per- cutaneous nephrolithotomy （PCNL） and the time for clipping the nephrostomy tube. [Methods] Clinical data of 386 patients undergoing PCNL performed by the same urologist from January 2011 to December 2013 in this hospital were retrospectively analyzed. All patients were randomized to two groups. Group 1 included 190 cases, the channels were untreated and the nephrostomy tube was clipped 2 h after surgery. Group 2 included 196 cases in whom chan- nels were routinely examined when the surgery finished, the electrocautery was used if there was obvious active bleeding and the hemostatic process video was attached, and the nephrostomy tube was clipped 0 to 48 h after surgery according to the condition of postoperative drainage. The postoperative hemorrhage and the decline of hemochrome were compared between two groups. [ Results ] Three patients in the former group with severe hemor- rhage after surgery were cured by the superselective renal artery embolization with the hemochrome declining 0.1 to 6.0 g, and the mean decline was 1.8 g. In the group 2, no cases had severe hemorrhage with the hemochrome de- clining 0.1 to 1.8 g, and the mean decline was 0.8 g. The decline of hemochrome in two groups was significantly different with the P 〈 0.01. [ Conclusion ] Routinely examining channel when the surgery finished is required and the electrocautery is needed when the obvious active bleeding occurres. And the time for clipping the nephrostomy tube is decided according to the condition of drainage after surgery.