腹腔镜外科杂志2023，Vol.28Issue(12)：925-928,938,5.DOI:10.13499/j.cnki.fqjwkzz.2023.12.925
微通道经皮肾镜取石术严重出血的原因及治疗策略
Causes and treatment strategies of severe hemorrhage in mini-percutaneous nephrolithotomy
徐秀民 1吴俊 1李玮 1左泽平 1龚强 1宇洪涛 1王月生 1朱金海 1钱俊杰 1王一行 1周军1
作者信息
- 1. 铜陵市人民医院泌尿外科,安徽 铜陵,244000
- 折叠
摘要
Abstract
Objective:To analyze the causes and treatment strategies of severe hemorrhage in minimally invasive percutaneous nephrolithotomy(mPCNL)for the treatment of upper urinary tract calculi.Methods:Clinical data were analyzed retrospectively in 23 upper urinary tract calculi patients who complicated with severe hemorrhage after mPCNL between Jun.2016 and May 2023.Results:There were 3 cases of intraoperative hemorrhage(13.04%),in which one case was performed nephrectomy due to important vascular injury;20 cases were postoperative hemorrhage(86.96%).6 cases(26.09%)cured after conservative treatment,and the average time of hemostasis in conservative treatment was(3.17±1.72)d.16 cases(69.57%)were treated by selective interventional embolization,and the average time of hemostasis was(2.25±1.66)d after selective embolization,of which 13 cases were cured after one selective embolization,and 3 cases were treated by selective embolization twice.Postembolization syndrome was found in 4 cases,including nausea,abdominal distension and low fever.Renal artery angiography showed 10 cases of renal arteriolar branch injury,3 cases of renal arteriovenous fistula,and 3 cases of renal pseudoaneurysm.Conclusions:Intraoperative and postoperative hemorrhage is the most com-mon and unavoidable complication of mPCNL.The key to prevention of severe hemorrhage is strict grasping the operative indication and standard surgical procedure during mPCNL.Most mild hemorrhage can be successfully treated by conservative treatment.If conservative treatment fails,selective renal artery embolization should be performed to control hemorrhage.Strict grasping the timing of interventional embolization is the key to successful hemostasis.关键词
上尿路结石/微通道经皮肾镜取石术/出血Key words
Upper urinary calculi/Mini-percutaneous nephrolithotomy/Hemorrhage分类
医药卫生引用本文复制引用
徐秀民,吴俊,李玮,左泽平,龚强,宇洪涛,王月生,朱金海,钱俊杰,王一行,周军..微通道经皮肾镜取石术严重出血的原因及治疗策略[J].腹腔镜外科杂志,2023,28(12):925-928,938,5.
