超声造影在经皮肾镜取石术后出血监测中的应用

Application of contrast-enhanced ultrasound in monitoring bleeding after percutaneous nephrolithotomy

目的探讨超声造影(CEUS)在经皮肾镜取石术(PCNL)后出血监测中的应用价值。方法收集2017年8月-2020年9月该院泌尿外科完成PCNL的患者1141例,回顾性分析22例根据临床病情需要行床旁CEUS并接受超选择性肾动脉栓塞术的患者的临床资料。结果1141例PCNL后因肾出血经保守治疗无效需行超选择性肾动脉栓塞术的共22例,发生率为1.93%。CEUS常规应用于PCNL后监测,术后第3天发现肾出血1例,术后第5天发现肾出血12例,术后第8天发现肾出血4例,术后第11天发现肾出血3例,术后第14天发现肾出血1例;1例术后第1天发生严重出血行介入失败,转开放手术。CEUS显示:肾假性动脉瘤15例,肾假性动脉瘤合并动静脉瘘5例,动静脉瘘1例,肾包膜下弥漫出血1例,与数字减影血管造影(DSA)检查相符。结论CEUS可随时、重复监测PCNL后的出血情况,明确肾内有无假性动脉瘤和(或)动静脉瘘,为及时采用超选择性肾动脉栓塞术治疗肾出血提供了临床诊断和治疗依据,并可作为患者术后随诊检查的首选。

Objective To investigate the application value of contrast-enhanced ultrasound(CEUS)in monitoring bleeding after percutaneous nephrolithotomy(PCNL).Methods From August 2017 to September 2020,1141 patients with PCNL were collected,a retrospective analysis was made on the clinical data of 22 patients who underwent bedside CEUS and super-selective renal artery embolization according to clinical conditions.Results Among of the 1141 patients with renal hemorrhage after PCNL,22 cases(1.93%)underwent super selective renal artery embolization.CEUS was routinely used to monitor renal hemorrhage after PCNL,renal hemorrhage was found in 1 case on day 3,12 cases on day 5,4 cases on day 8,3 cases on day 11,and 1 case on day 14.One patient was directly transferred to open surgery without ultrasound angiography because of continuous massive hematuria on the first day after surgery.Ultrasound angiography showed 15 cases of renal artery pseudoaneurysm,5 cases of renal artery pseudoaneurysm with arteriovenous fistula,and 1 case of arteriovenous fistula,which consistent with digital subtraction angiography(DSA).Conclusion CEUS can be used to repeatedly monitor the bleeding situation of patients after PCNL at any time to determine the presence of pseudoaneurysm and(or)arteriovenous fistula in the kidney,providing clinical diagnosis and treatment basis for the timely use of super-selective renal artery embolization for the treatment of renal hemorrhage,and can be used as the first choice for follow-up examination of patients after surgery.