经皮肾镜治疗上尿路结石出血附10例报告

目的：探讨经皮肾镜气压弹道联合超声碎石治疗上尿路结石出血的原因和治疗对策。方法：选取我院于2007年8月～2010年1月应用超声引导穿刺建立皮肤肾脏通道，经皮肾镜下采用瑞士EMS公司推出第3代气压弹道联合超声碎石清石系统治疗243例上尿路结石患者的临床资料，探讨术中术后出血的原因及治疗对策。结果：术中出血3例，经压迫止血后重新手术；术后出血7例，3例经保守治疗治愈，4例行选择性肾动脉介入栓塞治疗治愈；其中1例经介入栓塞后12h后血尿减轻后又加重，再次肾动脉造影发现新的出血部位，再次行介入栓塞治愈。结论：认识超声引导经皮肾镜气压弹道联合超声碎石治疗上尿路结石并发出血的原因，做好充分的术前准备，术中规范操作，手术技巧熟练，术中，术后及时处理，经保守治疗出血无明显改善，尽早急诊行选择性肾动脉介入栓塞，能有效防止PCNL出血的发生。

Treats on the urine road stone hemorrhage after Pi Shenjing to attach 10 examples to report

Objective：Discussion after Pi Shenjing in barometric pressure trajectory union supersonic crushed stone treatment urine road stone hemorrhage reason and treatment countermeasure. Methods： Selects my courtyard January,2010 to apply the supersonic guidance puncture establishment skin kidney channel in from August,2007 to,uses Swiss EMS Corporation after Pi Shenjing under to promote the 3rd generation of barometric pressure trajectory union supersonic crushed stone clear stone system to treat in 243 examples the urine road stone patient＇s clinical material,after the reason and the treatment countermeasure which in the discus- sion technique the technique bleeds. Results： In the technique bleeds 3 examples, after ligature again surgery; After the technique bleeds 7 examples,3 examples after the conservative treatment cure,4 routine selective renal artery involvement embolism treat the cure; 1 example 12h hematuria reduces after the involvement embolism aggravates, the renal artery radiography discovered once more the new hemorrhage spot,line of involvement embolism cures once more. Conclusion： Knew the supersonic guidance after Pi Shenjing in the barometric pressure trajectory union supersonic crushed stone treatment the urine road stone concurrent hemorrhage reason, prepares for in front of the full technique, in the technique the standard operation, the surgery skill is skilled,in technique, af- ter technique prompt processing,improves not obviously after the conservative treatment hemorrhage, emergency medical treatment good selective renal artery involvement embolism, can prevent effectively as soon as possible PCNL bleeds occurrence.