输尿管软镜碎石术后并发肾周血肿的诊治

Diagnosis and treatment of perirenal hematoma associated with ureteral flexible lithotripsy

目的:探讨输尿管软镜碎石术后发生肾周血肿的危险因素、预防以及治疗方法。方法:回顾性分析2007年4月至2016年8月的1 259例行输尿管软镜碎石术后出现症状性肾周血肿18例患者的临床资料,发生18例肾周血肿患者中合并糖尿病7例,合并尿路感染11例,其中女15例,男3例。结果:均经B超及CT检查确诊肾周血肿。血肿分别位于肾脏后外侧8例和肾脏腹侧及下极10例。血肿深度2.6~15.3cm(平均5.2 cm)。11例患者经保守治疗7~14 d后,血肿相关临床症状逐渐消失。5例行血肿穿刺抽液并置管引流,15d后逐渐痊愈,2例行开放手术清除血肿;36d后逐渐痊愈。结论:女性、糖尿病、尿路感染、结石体积大、手术时间长、感染性结石是输尿管软镜碎石术后并发肾周血肿的危险因素,术前充分准备和有效抗感染及术中提高碎石技巧和使用大口径输尿管通道鞘、低压灌注、缩短手术时间、分期手术等是减少肾周血肿发生的有效途径。

Objective To explore the risk factors, prevention and treatment of the occurrence of perirenal hematoma after flexible lithotripsy. Methods We retrospectively analyzed the clinical data of 18 patients with symptomatic perirenal hematoma from 1259 who had undergone ureteral flexible lithotripsy in our hospital during the period of April 2007 to April 2016. Of the 18 patients, 7 were complicated with diabetes mellitus, 11 had urinary tract infection; 15 were female, and 3 were male. Results Perirenal hematoma was confirmed by B ultrasound and CT, which situated on the Posterolateral side of the kidney in 8 patients, and on the lower pole and abdominal side in 10. Hematoma depth was 2.6-15.3 cm （average was 5.2 cm）. The hematoma-related symptoms gradually disappeared in 11 patients 7 to 14 days after they received conservative treatment. 5 recovered gradually 15 days after undergoing hematoma puncture and drainage, and 2 recovered 36 days after receiving open surgery for removal of hematoma. Conclusions Female, diabetes, urinary tract infection, bigger stone size, prolonged surgical duration, and infected stones were the risk factors for perinephric hematoma related to ureteroscopic lithotripsy. Full preoperative preparation, effective anti-infection, intraoperative improvement of calculus-breaking skills and use of large caliber semirigid through sheath, low pressure perfusion, shorter surgical duration, and staging surgery are effective ways to reduce the occurrence of perirenal hematoma.