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| 综合保守治疗经皮肾镜取石术后迟发性出血36例临床分析 |
| Clinical analysis of 36 cases of delayed hemorrhage after percutaneous nephrolithotomy with comprehensive conservative treatment |
| 投稿时间：2018-03-16 |
| DOI：10.3969/j.issn.1000-0399.2018.08.014 |
| 中文关键词: 经皮肾镜 迟发性出血 综合保守治疗 栓塞 |
| 英文关键词: Percutaneous nephrolithotomy Delayed hemorrhage Comprehensive conservative treatment Embolization |
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| 中文摘要: |
| 目的 探讨综合保守治疗在经皮肾镜取石术后迟发性出血治疗中的临床价值。方法 回顾性分析2012年12月至2017年9月安徽医科大学附属六安医院1 490例经皮肾镜取石术后发生迟发性出血的36例患者的临床资料和治疗经过。36例患者均采用综合保守治疗，包括卧床休息，夹闭肾造瘘管、调整肾造瘘管的深度和位置、经造瘘管注入去甲肾上腺素、提前取出双J管等。在治疗过程中观察患者的生命体征和血尿情况，并记录治疗结果。结果 33例患者经综合保守治疗1～3 d后血尿消失，成功率达91.67%。3例综合保守治疗无效的患者行超选择性肾动脉栓塞，均治愈出院。36例患者均痊愈，随访3～32个月，均再无血尿。结论 经皮肾镜取石术后迟发性出血患者采取综合保守治疗多数可获得满意疗效。少数经综合保守治疗无效者，可采用超选择性肾动脉栓塞止血。 |
| 英文摘要: |
| Objective To discuss the the clinical value of comprehensive conservative treatment in the treatment of delayed hemorrhage after percutaneous nephrolithotomy. Methods The clinical data and process of treatment of 36 patients with delayed hemorrhage after percutaneous nephrolithotomy in 1 490 cases of percutaneous nephrolithotomy patients from Dec 2012 to Sept 2017 at Lu'an Affiliated Hospital of Anhui Medical University were retrospectively analyzed. All patients were treated by comprehensive conservative treatment, including bed rest, closing the nephrostomy tube, adjusting the depth and location of nephrostomy tube, injecting norepinephrine from nephrostomy tube and removing double J ureteral catheters ahead of time.The vital signs and changes of hematuria in patients were observed during the treatment. Results The hematuria disappeared by comprehensive conservative treatment 1 to 3 days later in 33 cases, and the percentage of successful comprehensive conservative treatment was 91.67%. Three cases were treated by super selective renal artery embolization after ineffective conservative treatment. All 36 cases eventually recovered, and no hematuria was found during 3 to 32 months of follow-up. Conclusion The delayed hemorrhage after percutaneous nephrolithotomy can be mostly cured by comprehensive conservative treatment. Super selective renal artery embolization should be applied for a few patients with ineffective comprehensive conservative treatment. |
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