经皮肾镜在肝硬化高出血风险上尿路结石患者中的应用

Percutaneous nephrolithotomy for liver cirrhosis and upper urinarg calculus patients with coagulation disorders

目的探讨肝硬化上尿路结石患者行经皮肾镜碎石取石术(PCNL)的安全性及疗效。方法回顾性分析重庆北大阳光医院泌尿外科2015年5月~2017年11月行PCNL的13例肝硬化患者临床资料,分析13例患者术前及术后凝血功能指标、血红蛋白、结石清除率以及术中、术后出血情况。结果 13例患者中,平均手术时间为(61±6)min。术后有1例患者结石残留,予以保守口服排石药物治疗,结石清除率为92.3%(12/13)。术后患者血红蛋白平均为(88.6±5.2)g/L,平均下降(14.6±4.8)g/L。13例患者中,无严重并发症发生。围手术期输血3例,其中因术前严重贫血予以输血纠正1例,术后输入冷沉淀补充凝血因子后纠正出血1例,术后出血行高选择性左肾动脉介入栓塞术1例。结论 PCNL在肝硬化高出血风险患者中并非是绝对手术禁忌证,术前调控好患者的凝血功能指标,术后密切监测及治疗,PCNL对肝硬化患者上尿路结石的治疗是相对安全、有效的。

Objective To investigate the safety and clinical efficacy of percutaneous nephrolithotomy(PCNL)in liver cirrhosis patients complicated with upper urinary tract calculi.Methods Clinical data of 13 patients diagnosed with liver cirrhosis who underwent PCNL from May 2015 to November 2017 in the Department of Urology,Chongqing Peking Sunshine Hospital were retrospectively analyzed.Preoperative and postoperative coagulation function parameters,hemoglobin,stone removal rate and intraoperative and postoperative bleeding were analyzed.Results Among 13 patients,the average operation time was(61±6)min.One patient had residual calculi after surgery and was treated with conservative medication therapy.The stone removal rate was 92.3%(12/13).The average hemoglobin level after surgery was(88.6±5.2)g/L,which was decreased by(14.6±4.8)g/L on average.No severe complications occurred.During perioperative period,3 patients received blood transfusion.Among them,1 case received blood transfusion due to severe preoperative anemia,1 patient was treated by postoperative cryoprecipitate to supplement coagulation factors and 1 case received selective renal artery embolization due to postoperative bleeding.Conclusion PCNL is not an absolute contraindication for liver cirrhosis patients with a high risk of bleeding.PCNL is a relatively safe and efficacious treatment of the upper urinary tract calculi in patients with liver cirrhosis by preoperative regulation and postoperative monitoring of the coagulation function parameters.