微创经皮肾镜取石术并发严重出血的诊治

目的 探讨微创经皮肾镜取石术（MPCNL）并发严重出血的诊治方法.方法 回顾性分析2004年1月至2013年10月我院实施的1003例微创经皮肾镜取石术并发严重出血的29例患者资料,并统计分析经传统保守治疗及改进保守治疗病例的成功率.结果 13例（44.8％）经保守治疗治愈,14例（48.3％）行超选择性肾动脉栓塞术止血成功,经改进的保守治疗组成功率高于传统保守治疗组,差异具有统计学意义（P＜0.05）.2例（6.9％）患者最终行患肾切除术.无一例死亡.结论 MPCNL并发严重出血在选择性肾动脉栓塞术之前给予的干预治疗往往有效,如判断为静脉性出血经保守治疗无效时应果断行肾切除术.

Diagnosis and treatment for severe hemorrhagic following minimally invasive percutaneous nephrolithotomy

Objective To discuss the experience of diagnosis and treatment of severe hemorrhagic following minimally invasive percutaneous nephrolithotomy （MPCNL）. Methods A retrospective study was accomplished on 1003 patients with MPCNL in our hospital from Jan 2004 to Oct 2013. The success rate between the two groups of patients who were treated with traditional conservative treatment or improved conservative treatment were analysized successfully. Results 13 patients （44.8%）were treated successfully after conservative treatment, and 14 patients （48.3%）were treated after super-selective renal artery embolization when conservative treatment failed. The improved conservative treatment group success rate is higher than the traditional conservative therapy group with statistically significant differences （P〈0.05）. 2 patients （6.9%）eventually accepted nephrectomy, without deaths. Conclusions Conservative treatment for severe hemorrhagic following MPCNL is often effective before using the super-selective renal artery embolization. Resolutely performing nephrectomy if conservative therapy has no effect on the venous bleeding.