微通道经皮肾镜取石术后症状性肾周血肿的诊治

目的：总结微通道经皮肾镜取石术后症状性肾周血肿的诊治方法。方法：回顾性分析15例行微通道经皮肾镜取石术后出现症状性肾周血肿患者的临床资料,总结其治疗措施和结果。结果：15例患者经B超检查发现肾周血肿．13例再行cT检查确诊。血肿部位：肾脏后外侧13例、肾脏下极及腹侧2例。血肿深度1．8。8．2em（平均3．6cm）。4例患者经单纯药物治疗3—10d后,血肿相关临床症状逐渐消失。3例行血肿穿刺抽液．4．7d后相关症状逐渐消失;6例行血肿穿刺抽液并置管引流,其中5例引流3～7d后．患者临床症状得以控制并拔除引流管,1例感染症状持续存在,最终行开放手术清除血肿;3例行开放手术清除血肿．7．10d后逐渐痊愈。获得血肿液体样本11例,其中合并细菌感染者4例。结论：对于微通道经皮肾镜取石术后症状性肾周血肿,及时诊断后采用恰当的药物治疗或联合外科处理能取得较好的疗效。

Diagnosis and treatment of symptomatic perirenal hematoma following mini- percutaneous nephrolithotomy

Objective：To summarize the diagnosis and treatment of perirenal hematoma following mini- percutaneous nephrolithotomy. Methods： We retrospectively analyzed the clinical profiles of 15 patients with perirenal hematoma following mini-percutaneous nephrolithotomy for summary of therapeutic measures and relevant outcomes. Results： Of 15 patients presented with perirenal hematoma via uhrasonography, 13 were confirmed by computed tomography. The hematoma, presented in the diameter of 1.8 - 8.2cm （ mean ： 3.6 cm）, was located in the posterior lateral renal region （n = 13 ） and lower polar and abdominal region （n = 2）. 4 patients had a remission of hematoma-associated symptoms following treatment with medications for 3 to 10 days ; 3 patients had a remission following puncture drainage for 4 to 7 days. Of 6 patients who were treated with puncture drainage, 5 had an improved clinical symptoms and were extubated following treatment for 3 to 7 days, whilst the remaining single case required open surgery for clearing the hematoma because of persistent infection. 3 patients who were treated with open-abdomen surgery for clearing the hematoma recovered at days 7 to 10. Of 11 hematoma samples, 4 tested positively to bacterial examination. Conclusion： Timely diagnosis followed by adequate medication treatment or surgery may achieve preferable outcomes in patients with perirenal hematoma following mini-pereutaneous nephrolithotomy.