经皮肾镜取石术后出血行超选择性肾动脉栓塞时机探讨
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摘要
目的探讨经皮肾镜取石术后出血行超选择性肾动脉栓塞的合理时机。方法方便选取该院2014年月1月—2018年12月期间上尿路结石患者1 298例(共1 192个肾脏)接受经皮肾镜取石术治疗,手术治疗后20例患者由于严重出血而接受超选择性肾动脉栓塞治疗。该次研究就回顾性分析20例患者的出血特点和接受超选择性肾动脉栓塞治疗时机。结果全部患者中接受1次超选择性肾动脉栓塞治疗后止血成功的患者共19例,其中1例患者在超选择性肾动脉栓塞治疗前接受单纯性肾动脉造影;接受2次超选择性肾动脉栓塞治疗后止血成功的患者共1例。全部患者接受初次单纯性肾动脉造影或超选择性肾动脉栓塞时血色素平均降低(33.0±2.2)g/L,输血量(247.6±16.8)m L;再次接受单纯性肾动脉造影或超选择性肾动脉栓塞时血色素平均降低(3.15±0.51)g/L,未进行输血;20例患者均康复出院。结论经皮肾镜取石术后严重出血患者需尽早开展超选择性肾动脉栓塞,初次单纯性肾动脉造影阴性或超选择性肾动脉栓塞后再出血患者需酌情开展超选择性肾动脉栓塞。
Objective To investigate the rational timing of superselective renal artery embolization after percutaneous nephrolithotomy. Methods Convenient select a total of 1 298 patients(1 192 kidneys) who underwent upper urinary calculi during the period from January 2014 to December 2018 in our hospital were treated with percutaneous nephrolithotomy. 20 patients underwent surgery for severe bleeding selective renal artery embolization. This study retrospectively analyzed the bleeding characteristics of 20 patients and the timing of treatment with superselective renal artery embolization. Results A total of 19 patients with successful hemostasis after one-time superselective renal artery embolization were treated in all patients. 1 patient underwent simple renal angiography before superselective renal artery embolization; A total of 1 patients with successful hemostasis after renal artery embolization. All patients underwent primary simple renal angiography or superselective renal artery embolization with a decrease in hemoglobin(33.0±2.2) g/L, blood transfusion(247.6±16.8) m L; reacceptable simple renal angiography or superselective kidney mean hemoglobin was decreased(3.15±0.51) g/L during arterial embolization, and no transfusion was performed; 20 patients were discharged from hospital. Conclusion Patients with severe hemorrhage after percutaneous nephrolithotomy should undergo superselective renal artery embolization as soon as possible. Patients with primary simple renal angiography or re-selective renal artery embolization should be treated with superselective renal artery embolization as appropriate.
Objective To investigate the rational timing of superselective renal artery embolization after percutaneous nephrolithotomy. Methods Convenient select a total of 1 298 patients(1 192 kidneys) who underwent upper urinary calculi during the period from January 2014 to December 2018 in our hospital were treated with percutaneous nephrolithotomy. 20 patients underwent surgery for severe bleeding selective renal artery embolization. This study retrospectively analyzed the bleeding characteristics of 20 patients and the timing of treatment with superselective renal artery embolization. Results A total of 19 patients with successful hemostasis after one-time superselective renal artery embolization were treated in all patients. 1 patient underwent simple renal angiography before superselective renal artery embolization; A total of 1 patients with successful hemostasis after renal artery embolization. All patients underwent primary simple renal angiography or superselective renal artery embolization with a decrease in hemoglobin(33.0±2.2) g/L, blood transfusion(247.6±16.8) m L; reacceptable simple renal angiography or superselective kidney mean hemoglobin was decreased(3.15±0.51) g/L during arterial embolization, and no transfusion was performed; 20 patients were discharged from hospital. Conclusion Patients with severe hemorrhage after percutaneous nephrolithotomy should undergo superselective renal artery embolization as soon as possible. Patients with primary simple renal angiography or re-selective renal artery embolization should be treated with superselective renal artery embolization as appropriate.
引文
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[10]赖颖.综合护理在微创经皮肾镜取石术治疗复杂性肾结石52例中的应用[J].中国民族民间医药,2015(23):120.
[11]Zeng G,Zhang T,Agrawal M,et al.Super-mini percutaneous nephrolithotomy(SMP)vs retrograde intrarenal surgery for the treatment of 1-2 cm lower-pole renal calculi:an international multicentre randomised controlled trial[J].BJUinternational,2018,122(6):1034-1040.
[2]桑士仿,葛庆生,徐鹏程.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[J].安徽医学,2018,39(8):948-951.
[3]王宇光.经皮肾镜取石术治疗肾结石的效果及出血相关因素探究[J].中外医疗,2018,37(31):85-87.
[4]徐飞,路志民,郭明涛,等.B超引导下微创经皮肾镜取石术治疗肾结石的疗效及出血因素分析[J].医学研究杂志,201746(9):131-133.
[5]段灵星,匡仁锐,张谏,等.单通道与多通道经皮肾镜取石术治疗复杂性肾结石有效性和安全性的Meta分析[J].转化医学杂志,2019,8(1):45-49.
[6]Ozgor F,Yanaral F,Savun M,et al.Comparison of STONE,CROES and Guy's nephrolithometry scoring systems for predicting stone-free status and complication rates after?percutaneous nephrolithotomy in obese patients[J]Urolithi asis,2018,46(5):471-477.
[7]胡常华,胡晓泉,王磊.微创经皮肾镜碎石取石术的临床疗效和术中及术后出血风险因素分析[J].中华全科医学2015,13(10):1727-1729.
[8]Kati B,Buyukfirat E,Pelit ES,Yagmur I,et.al.Percutaneous Nephrolithotomy with Different Temperature Irrigation and Effects on Surgical Complications and Anesthesiology Applic ations[J].Journal of endourology,2018,32(11):1050-1053.
[9]瞿伟,陈东,钟鸿烈.微创经皮肾取石术治疗无积水肾结石临床研究[J].中国实用医药,2019,14(4):45-46.
[10]赖颖.综合护理在微创经皮肾镜取石术治疗复杂性肾结石52例中的应用[J].中国民族民间医药,2015(23):120.
[11]Zeng G,Zhang T,Agrawal M,et al.Super-mini percutaneous nephrolithotomy(SMP)vs retrograde intrarenal surgery for the treatment of 1-2 cm lower-pole renal calculi:an international multicentre randomised controlled trial[J].BJUinternational,2018,122(6):1034-1040.