经皮肾镜手术继发出血的处理分析

Treatment of bleeding complications in percutaneous nephrolithotomy

目的:分析采用经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)治疗上尿路结石发生继发出血并发症的处理方法及其效果。方法:回顾性分析内江市第一人民医院824例PCNL治疗肾结石患者的临床资料。结果:16例(1.94%)发生继发出血并发症,其中术中出血3例,术后30 d内继发出血13例。所有16例中采用输血治疗者10例(62.5%),全部患者均未行肾切除,其中7例经气囊压迫、绝对卧床休息、抗感染、止血药物等综合治疗痊愈,9例患者急诊行肾动脉造影、选择性肾动脉栓塞术(digital subtrection angiography,DSA)治疗成功。结论:PCNL继发出血是该手术难以绝对预防的并发症,与穿刺通道选择是否理想、是否暴力操作及是否合并感染等因素有关,严重者可危及患者生命。术中操作规范是预防其发生的关键,一旦发生要准确把握介入治疗(DSA)时机。

Objective:To analyze the methods and results for solving bleeding complications in PCNL( percutaneous nephrolithotomy).Methods:The data of 824 patients with kidney stones treated by PCNL was retrospectively analyzed. Results: 16 of them( 1 .94% ) had secondary hemorrhage complication ,3 daring operation, 13 in 30 days after operation. 10 of them accepted blood transfusionaccounting for 62. 5% . There was no nephretomy. 7 patients healed through absolute rest in bed,local oppression, anti-inflammatory,the other 9 patients healed through super selective renal arterial embolization. Conclusion : Bleeding complication in PCNL is difficultto predict and can be life-threatening, related to unideal puncturing tract, infection, etc. When it happened, deciding interventionaltherapy in time is the most important thing.