微创经皮肾穿刺取石术并发严重出血的原因分析及处理

目的探讨微创经皮肾穿刺取石术并发严重出血的原因及防治措施。方法 2006年3月～2011年4月行482例微创经皮肾镜取石术,21例并发严重出血,16例采用夹管等保守治疗有效,5例保守治疗无效后行超选择性肾动脉栓塞术。结果术中严重出血13例,9例经过相应处理后,继续碎石取石;3例中止手术,行二期碎石取石;1例保守治疗无效行介入栓塞治疗。术后发生严重出血8例,4例经保守治疗有效,3例行肾动脉造影并选择性肾血管栓塞止血一次性治愈,1例3d后再次行栓塞治疗后治愈。21例术后随访3～24个月,平均12个月,血尿素氮及肌酐均正常,血压无明显改变。结论微创经皮肾取石术并发出血应以预防为主,准确穿刺定位及提高通道扩张技巧,可减少出血;出血不止或反复出血首选介入栓塞治疗。

Causes and Management of Severe Hemorrhage during and after Minimally Invasive Percutaneous Nephrolithotomy

Objective To discuss the causes and treatment of severe hemorrhage during or after minimally invasive percutaneous nephrolithotomy(mPCNL).Methods A retrospectively study was made on 482 patients,who received mPCNL from March 2006 to April 2011.Among the patients,severe hemorrhage occurred in 21 of them.Conservative therapy was carried out in the patients,and was effective in 16 of them,the other 5 then underwent super-selective renal arterial embolization.Results The severe hemorrhage occurred during mPCNL in 13 patients,the procedure was completed in 9 of them after the bleeding was controlled,but was suspended in 3,who received a second mPCNL later;the other 1 patient received embolization after failure in conservative therapies.Postoperative massive hemorrhage was found in 8 patients,4 of them were cured by conservative therapies,3 recovered after super-selective renal arterial embolization,and the other one was cured after a second embolization in 3 days after the first one.The 21 patients were followed up for 3-24 months with a mean of 12 months,during which no abnormal blood urea nitrogen or blood pressure was detected.Conclusions Prevention should be put first for hemorrhage during or after mPCNL.Accurate puncture and skillful tunnel expansion are the keys to minimize the hemorrhage.Interventional embolization should be the first choice in case of massive or repeated bleeding.