超声引导下经皮肾脏穿刺活检后大出血的诊治体会

Diagnosis and treatment experience of massive hemorrhage after ultrasound-guided percutaneous renal puncture biopsy

大出血是超声引导下经皮肾脏穿刺活检后最严重的并发症之一,严重者可能导致患者单侧肾脏切除,甚至病死。临床通常认为,术前把握好肾穿刺活检指征,做好术前准备,术中规范操作,术后严格管理,可以降低肾脏出血发生概率,或减轻出血严重程度,但仍然不能完全避免穿刺后大出血的发生。本文通过回顾1例超声引导下经皮肾脏穿刺活检后大出血患者的诊治过程,以及相关文献复习,从患者自身因素、术前准备、穿刺方法、术后管理等方面,探讨肾脏穿刺活检出血的危险因素,并从出血判断、处理等方面,总结肾脏穿刺活检后大出血的诊治经验。

Massive hemorrhage is one of the most serious complications after ultrasound-guided percutaneous renal puncture biopsy,and the most serious cases may lead to unilateral nephrectomy or even death.It is generally believed that grasping the indications of renal puncture biopsy before operation,making good preoperative preparations,standardizing intraoperative operation and implementing strict postoperative management can reduce the probability of renal hemorrhage or relieve the severity of hemorrhage.However,it still cannot completely avoid the occurrence of massive hemorrhage after puncture.By recalling the diagnosis and treatment process of a patient with massive hemorrhage after ultrasound-guided percutaneous renal puncture biopsy,and reviewing relevant literature,the risk factors of renal puncture biopsy hemorrhage from the aspects of patients’own factors,preoperative preparations,puncture methods and postoperative management were investigated in this paper.Meanwhile,the diagnosis and treatment experience of massive hemorrhage after renal puncture biopsy is summarized from the aspects such as he morrhage judgment and treatment.