肾穿刺造瘘和尿激酶注射联合治疗体外冲击波碎石后肾包膜下血肿

The application of percutaneous renal subcapsular hematoma drainage and urokinase to treat renal subcapsular hematoma resulted from extracorporeal shock wave lithotripsy

目的 :探讨肾穿刺造瘘和尿激酶局部注射治疗体外冲击波碎石 (ESWL)后肾包膜下血肿的价值。方法 :对ESWL后肾包膜下巨大血肿患者 2例 ,在B超定位下行肾包膜下血肿穿刺造瘘术 ,引流出陈旧性出血后 ,每隔 3～ 4d间断向血肿内注入尿激酶 2 0～ 5 0万IU并保留 2 4h ,然后充分引流。结果 :穿刺造瘘后的第 3～ 4天内引流出陈旧性积血 5 1～ 98ml,注入尿激酶溶解血凝块 ,1个月后血肿体积约为治疗前的 1/ 35～ 1/ 15。经 14～ 18个月随访 ,无继发出血、感染、高血压等并发症。结论 :对ESWL后肾包膜下巨大血肿患者行穿刺造瘘置管引流术 ,同时局部应用尿激酶溶解血凝块 ,可有效溶解引流肾包膜下陈旧性出血和血凝块 。

Objective:To study The application of percutaneous renal subcapsular hematoma ostomy and local application of urokinase to treat renal subcapsular hematoma resulted from extracorporeal shock wave lithotripsy. Methods:Percutaneous renal subcapsular hematoma ostomy was employed to treat 2 patients with renal subcapsular hematoma following extracorporeal shock wave lithotripsy, then 500,000 to 200,000 IU urokinase was injected into renal subcapsular hematoma and reserved for 24 hours every 3 or 4 days. Results:51～98 ml old blood was poured in the first 3 days. The volume of renal subcapsular hematoma was decreasd gradually after urokinase injection. The patients were Followed up for 14～18 months, the complications of active bleeding,infection and hypertension were not found. Conclusions:Percutaneous renal subcapsular hematoma ostomy and local application of urokinase are better method to treat renal subcapsular hematoma resulted from extracorporeal shock wave lithotripsy of the kidney.