BACKGROUND Bilateral perirenal hematoma is rarely reported in endoscopic management of horseshoe kidney stones,and there are few studies reporting the formation of bilateral hematoma following tubeless percutaneous ne...BACKGROUND Bilateral perirenal hematoma is rarely reported in endoscopic management of horseshoe kidney stones,and there are few studies reporting the formation of bilateral hematoma following tubeless percutaneous nephrolithotomy(PCNL)for unilateral horseshoe kidney calculi.CASE SUMMARY A 32-year-old man was admitted to our hospital because of repeated intermittent hematuria for 10 years.Plain abdominal computed tomography(CT)scan revealed calculi in the horseshoe kidney;the largest being 2 cm in diameter.Tubeless PCNL was performed to remove the stones.Three days after the operation,the patient was discharged in a stable situation.Three days after discharge,the patient presented to our emergency department because of right low back pain and vomiting.Emergent CT scan revealed subcapsular and perirenal hematocele and exudates in both kidneys.Ultrasound-guided puncture and drainage of perirenal effusion were performed.After the temperature stabilized,the patient received low-pressure injection of urokinase 100000 U for 3 d.His routine blood indexes and the renal function returned to normal in 3 wk.CT re-examination 3 mo after lithotripsy showed that the subcapsular and perirenal hematoma and exudates in both kidneys were significantly absorbed as compared with those before.The patient was followed up for 1 year,during which no flank pain or hematuria recurred.CONCLUSION This is the first case report on the formation of bilateral hematoma following tubeless PCNL for unilateral horseshoe kidney calculi.展开更多
目的系统评价国内成人无管化与标准化经皮肾镜取石术两种手术方式治疗上尿路结石的安全性和有效性。方法系统检索Pub Med、EMBASE、Cochrane临床对照试验资料库(CENTRAL)、The ISI Web of Knowledge Databases、中国生物医学文献数据库(...目的系统评价国内成人无管化与标准化经皮肾镜取石术两种手术方式治疗上尿路结石的安全性和有效性。方法系统检索Pub Med、EMBASE、Cochrane临床对照试验资料库(CENTRAL)、The ISI Web of Knowledge Databases、中国生物医学文献数据库(CBM)、中文期刊全文数据库(CNKI)和维普中文科技期刊数据库(VIP)、万方数据库,并辅以手工检索,检索时间均为建库至2014年3月,查找所有研究比较无管化和标准化经皮肾镜取石术(PCNL)治疗上尿路结石的随机对照试验(RCT),按纳入排除标准由两人独立进行RCT的筛选、资料提取和质量评价,采用Re Man 5.1软件进行Meta分析。结果共纳入8项研究,661例患者。Meta分析结果显示:与标准化PCNL相比,无管化PCNL缩短手术时间、住院时间、术后重返工作时间以及术后漏尿时间,降低术后疼痛评分,减少镇痛药物需求病例数,减少镇痛药物使用量,而结石清除率、尿外渗、术后发热病例、术后血红蛋白下降量、大出血发生率以及术后输血病例方面无差异。结论基于目前所纳入的随机对照试验,无管化与标准化经皮肾镜取石术两种术式相比,在手术时间、住院时间,术后疼痛等方面存在优势,而在结石清除率、大出血、术后发热等方面并无明显差异,可以看出无管化经皮肾镜是有效、安全、经济的上尿路结石治疗手段。但由于该系统评价纳入研究数量少,原始研究质量较低,且有存在选择偏倚、实施偏倚与发表偏倚的可能性,需要更多高质量、大样本的随机对照试验提供更可靠的证据,建议临床严格把握适应证,选择性的使用相应术式。展开更多
基金Supported by Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2019KY575(to Zhou C).
文摘BACKGROUND Bilateral perirenal hematoma is rarely reported in endoscopic management of horseshoe kidney stones,and there are few studies reporting the formation of bilateral hematoma following tubeless percutaneous nephrolithotomy(PCNL)for unilateral horseshoe kidney calculi.CASE SUMMARY A 32-year-old man was admitted to our hospital because of repeated intermittent hematuria for 10 years.Plain abdominal computed tomography(CT)scan revealed calculi in the horseshoe kidney;the largest being 2 cm in diameter.Tubeless PCNL was performed to remove the stones.Three days after the operation,the patient was discharged in a stable situation.Three days after discharge,the patient presented to our emergency department because of right low back pain and vomiting.Emergent CT scan revealed subcapsular and perirenal hematocele and exudates in both kidneys.Ultrasound-guided puncture and drainage of perirenal effusion were performed.After the temperature stabilized,the patient received low-pressure injection of urokinase 100000 U for 3 d.His routine blood indexes and the renal function returned to normal in 3 wk.CT re-examination 3 mo after lithotripsy showed that the subcapsular and perirenal hematoma and exudates in both kidneys were significantly absorbed as compared with those before.The patient was followed up for 1 year,during which no flank pain or hematuria recurred.CONCLUSION This is the first case report on the formation of bilateral hematoma following tubeless PCNL for unilateral horseshoe kidney calculi.
文摘目的系统评价国内成人无管化与标准化经皮肾镜取石术两种手术方式治疗上尿路结石的安全性和有效性。方法系统检索Pub Med、EMBASE、Cochrane临床对照试验资料库(CENTRAL)、The ISI Web of Knowledge Databases、中国生物医学文献数据库(CBM)、中文期刊全文数据库(CNKI)和维普中文科技期刊数据库(VIP)、万方数据库,并辅以手工检索,检索时间均为建库至2014年3月,查找所有研究比较无管化和标准化经皮肾镜取石术(PCNL)治疗上尿路结石的随机对照试验(RCT),按纳入排除标准由两人独立进行RCT的筛选、资料提取和质量评价,采用Re Man 5.1软件进行Meta分析。结果共纳入8项研究,661例患者。Meta分析结果显示:与标准化PCNL相比,无管化PCNL缩短手术时间、住院时间、术后重返工作时间以及术后漏尿时间,降低术后疼痛评分,减少镇痛药物需求病例数,减少镇痛药物使用量,而结石清除率、尿外渗、术后发热病例、术后血红蛋白下降量、大出血发生率以及术后输血病例方面无差异。结论基于目前所纳入的随机对照试验,无管化与标准化经皮肾镜取石术两种术式相比,在手术时间、住院时间,术后疼痛等方面存在优势,而在结石清除率、大出血、术后发热等方面并无明显差异,可以看出无管化经皮肾镜是有效、安全、经济的上尿路结石治疗手段。但由于该系统评价纳入研究数量少,原始研究质量较低,且有存在选择偏倚、实施偏倚与发表偏倚的可能性,需要更多高质量、大样本的随机对照试验提供更可靠的证据,建议临床严格把握适应证,选择性的使用相应术式。
