血友病A患者上尿路结石碎石治疗的初步探讨

Preliminary Study on the Treatment of Upper Urinary Tract Stone Lithotripsy in Patients with Hemophilia A

目的:初步探讨血友病A患者上尿路结石的碎石疗效和围手术期的处理。方法:回顾性分析23例血友病A患者上尿路结石的碎石治疗方法,包括体外碎石术(ESWL)、输尿管镜下钬激光碎石术(URL)以及经皮肾镜碎石术(PCNL),记录围手术期凝血因子Ⅷ浓度及凝血因子使用情况,通过与23例非血友病人群相比,进一步观察疗效和安全性。结果:术后随访6个月,23例患者共成功20例,剩余2例重复手术后成功,1例临床症状缓解后随访。经过规范的围手术期凝血因子Ⅷ浓度测定及凝血因子替代治疗,所有患者均恢复良好,通过与非血友病人群相比,手术成功率相仿,手术出血量并没有增多。结论:如果围手术期凝血因子水平和凝血功能能够维持在一定范围,血友病A患者上尿路结石行碎石治疗还是安全有效的。

Objective：To investigate the curative effects of lithotripsy and perioperative management of upper urinary calculi in patients with hemophilia A.Methods：Methods of lithotripsy for upper urinary tract calculi in 23 patients with hemophilia A were retrospectively analyzed,including extracorporeal lithotripsy（ESWL）,ureteroscopic holmium laser lithotripsy（URL）and percutaneous nephrolithotripsy（PCNL）.The concentration of coagulation factorⅧ and the usage of coagulation factor in perioperative period were recorded.Compared with 23 cases of non-hemophilia,the curative effect and safety were further observed.Results：Over a follow-up period of six months after surgery,20 cases were successfully performed,the remaining 2 cases were successful after repeated operations,and 1 case was followed up after remission of clinical symptoms.After standard perioperative coagulation factor VIII concentration measurement and coagulation factor replacement therapy,all patients recovered well.Compared with non-hemophilic patients,the success rate of surgery was similar,and the amount of surgical bleeding did not increase.Conclusion：If coagulation factor level and coagulation function can be maintained in a certain range during perioperative period,lithotripsy for upper urinary tract stones in hemophilia A patients is safe and effective.