输尿管软镜碎石术后并发肾周血肿的诊治

发布时间：2018-11-15 20:24

【摘要】：目的:探讨输尿管软镜碎石术后发生肾周血肿的危险因素、预防以及治疗方法。方法:回顾性分析2007年4月至2016年8月的1 259例行输尿管软镜碎石术后出现症状性肾周血肿18例患者的临床资料,发生18例肾周血肿患者中合并糖尿病7例,合并尿路感染11例,其中女15例,男3例。结果:均经B超及CT检查确诊肾周血肿。血肿分别位于肾脏后外侧8例和肾脏腹侧及下极10例。血肿深度2.6~15.3cm(平均5.2 cm)。11例患者经保守治疗7~14 d后,血肿相关临床症状逐渐消失。5例行血肿穿刺抽液并置管引流,15d后逐渐痊愈,2例行开放手术清除血肿;36d后逐渐痊愈。结论:女性、糖尿病、尿路感染、结石体积大、手术时间长、感染性结石是输尿管软镜碎石术后并发肾周血肿的危险因素,术前充分准备和有效抗感染及术中提高碎石技巧和使用大口径输尿管通道鞘、低压灌注、缩短手术时间、分期手术等是减少肾周血肿发生的有效途径。
[Abstract]:Objective: to investigate the risk factors, prevention and treatment of perirenal hematoma after ureteral soft lithotripsy. Methods: the clinical data of 1 259 patients with symptomatic perirenal hematoma after ureteral soft lithotripsy from April 2007 to August 2016 were retrospectively analyzed. Among the 18 patients with perirenal hematoma, 7 cases were complicated with diabetes mellitus. 11 cases were complicated with urinary tract infection, of which 15 cases were female and 3 cases were male. Results: the diagnosis of perirenal hematoma was confirmed by B-ultrasound and CT. Hematoma was located in 8 cases of posterolateral kidney and 10 cases of ventral side and lower pole of kidney. The hematoma depth 2.6~15.3cm (mean 5.2 cm).) in 11 patients with hematoma disappeared gradually after conservative treatment for 7 ~ 14 days, and 5 cases were treated with hematoma puncture and drainage, and recovered gradually after 15 days. 2 cases were treated with open operation to remove hematoma. After 36 days, the patients recovered gradually. Conclusion: female, diabetes mellitus, urinary tract infection, large stone volume, long operation time, infectious stone are the risk factors of perirenal hematoma after ureteral soft lithotripsy. The effective ways to reduce perirenal hematoma are to prepare and effectively resist infection before operation, to improve lithotripsy skills, to use large diameter ureteral passage sheath, to infuse low pressure, to shorten operation time, and to operate by stages.
【作者单位】：广州医科大学附属第五医院泌尿外科广州医科大学微创外科技术和产品转化中心;中山大学附属第一医院泌尿外科;
【分类号】：R699.4

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