【作者】 宁坷平； 祖雄兵； 齐琳； 陈合群； 杨中青； 高宁；

【Author】 NING Keping, ZU Xiongbing, QI Lin ,CHEN Hequn, YANG Zhongqing, GAO Ning. Department of Urology, Xiangya Hospital, Central South University, Changsha 410008 China

【机构】 中南大学湘雅医院泌尿外科；

【摘要】 目的:分析微创经皮肾镜碎石取石术(Minimally Invasive Percutaneous Nephrdithotomy,MPCNL)大出血的原因,并探讨出血的预防与控制,及介入栓塞术对止血的效果及相关经验。方法:回顾性分析本院2004年10月至2008年6月间10例MPCNL大出血患者的临床资料,其中男性9例,女性1例,年龄36～73岁,平均50岁。对出血原因,出血的预防与控制及介入栓塞止血治疗的效果进行分析和探讨。结果:MPCNL术并发出血10例,其中术中出血2例,术后出血8例,术中出血多为建立穿刺通道时以及进入集合系统后碎石时血管或肾实质损伤引起,术后出血多为假性动脉瘤、动静脉瘘形成等。10例出血患者均行了介入栓塞治疗,止血效果好,术后血压、血常规及肾功能情况恢复好。结论:超选择肾动脉介入栓塞技术治疗MPCNL并发的严重出血,是安全有效的,而且能很大程度上保留肾组织和保护肾功能。更多还原

【Abstract】 Objective: To analyze the cause of the hemorrhage following the MPCNL, and to approach the prevention of the hemorrhage, summarize the experience in the interventional treatment of severe bleeding after MPCNL by superselective arteriolar embolization. Methods: From Oct 2004 to Jun 2008, 10 cases (9 men and 1 woman, mean age 50 years)who developed severe bleeding following MPCNL were identified, the cause, the prevent,and treatment of the hemorrhage were analyzed. Results: 10 patients who had severe bleeding following the MPCNL, the number of hemorrhage in the MPCNL was 2, the number of the hemorrhage after the MPCNL was 8. The bleeding in the MPCNL mainly caused by the injure of the artery and the renal parenchyma when the renal puncture passage was established, and the cause of hemorrhage after the MPCNL almost were the false aneurysm and the arteriovenous fistula. All these bleeding patients were successfully treated by the superselective arteriolar embolization. And the BR, BP, renal fuction recovered well. Conclusion:The superselective arteriolar embolization to treat the hemorrhage following the MPCNL was safe and effective, and could protect the renal fuction well.更多还原