肾结石ESWL后肾脏血肿的原因分析

目的:探讨肾结石ESWL后肾脏血肿的原因。方法:对2008年5月~2012年6月5例肾结石ESWL后肾脏血肿的临床资料进行分析并文献复习。结果:采用上海交通大学JDPN-ⅤB型液电式碎石机治疗后引起肾脏血肿3例,深圳惠康HK.ESWL-109型电磁式碎石机治疗引起2例。体型肥胖并高血压2例(其中1例糖尿病)。2例因输尿管结石梗阻感染行输尿管镜取石术后行同侧肾结石ESWL后出现肾脏血肿,2例行一侧输尿管结石ESWL后行对侧肾结石ESWL后出现肾脏血肿,1例右输尿管上段结石ESWL后部分结石上移肾内行肾结石ESWL后出现肾脏血肿。4例保守治疗痊愈(肾包膜下血肿2例,肾包膜破裂肾周血肿2例);1例肾周大血肿腹膜后扩散,输血3 500ml,行高选择性肾动脉分支栓塞治愈。结论:ESWL并非绝对安全、没有重大并发症,只有掌握合适的适应证才安全可靠,在治疗前后需要仔细观察和评估。导致肾脏血肿的易患因素有凝血功能异常、抗凝药物的使用、糖尿病、高血压、老年患者、心脏病、肥胖等因素。高低能量冲击波的交替使用,有助于提高碎石的成功率及安全性。绝大多数患者可以通过保守治疗治愈,少数需要肾动脉栓塞治疗,个别严重患者需要肾切除来挽救生命。

Causes of renal hematoma after extracorporeal shock wave lithotripsy

Objective.. To analyze the causes of renal hematoma after ESWL in patients with kidney stones. Method：The data of five cases suffering from nephric hematomas after ESWL from May 2008 to June 2012 were analyzed retrospectively. Result ~ Three cases with kidney hematomas were caused by Shanghai Jiaotong University JDPN-V B-type electrohydraulic lithotriptor after ESWL, and two cases by Shenzhen HK. ESWL-109-type elec- tromagnetic lithotriptor. Obesity and hypertension were found in two cases （one case diabetes）. Two cases with upper urinary infections due to ureteral calculi obstruction had renal hematomas after ESWL for ipsilateral kidney stones. Two cases had renal hematomas after ESWL for contralateral kidney stones. Another one case with right upper ureteral calculi had renal hematoma after ESWL for intrarenal stones from ureter. Four cases were cured conservatively including two subcapsular hematomas and two perirenal hematomas. One case with retroperitoneal hematoma cured by superselective renal arterial embolization and blood transfusion of 3 500 ml,. Conclusion：ESWL is not absolutely a safe procedure because of some inevitable major complications unless appropriate indications are closely noticed. It requires deliberate managements before and after ESWL. The risk factors of renal hematoma are eoagulopathy, anticoagulant drug use, diabetes, hypertension, elderly patients, heart disease, obesity and other factors. Alternating high and low energy shock wave make the procedure more successful and safer. Most of the patients can be cured conservatively, but a few need superselective renal arterial embolization. Unfortunately only few patients need neohrectomv to save their lives.