CAJ | 학술논문

探究经皮肾镜碎石术术后大出血的原因及防治措施。方法选取2008年1月～2013年1月到我院泌尿外科进行经皮肾镜碎石术术后大出血的35例患者作为研究对象，分析造成病人出现术后大出血的原因，并对原因进行统计学分析，找出可能引起大出血发生率增大的因素，对出血的预防与控制提供临床参考，并对出血病人进行介入栓塞止血的临床效果进行分析及讨论。结果35例患者术后出血量800～2700ml，平均出血量(1200±680)ml。所有患者在出血后，均先以扩容﹑输血﹑局部压迫止血﹑药物止血﹑闭管等保守治疗进行止血，其中16(45.7%)例患者出血情况得到控制，19(54.3%)例患者经紧急介入栓塞治疗后，18例痊愈，其中1例因出血量过多而转行肾脏切除术。结论手术前的充分准备，提高手术的熟练度，减少手术时间，及时有效的治疗是防治术后大出血的重要保障；对于出现大出血的患者进行及时的介入栓塞止血，可降低肾功能受损的机率，是经皮肾镜碎石术术后大出血的首选治疗方法。
탐구경피신경쇄석술술후대출혈적원인급방치조시。방법선취2008년1월～2013년1월도아원비뇨외과진행경피신경쇄석술술후대출혈적35례환자작위연구대상，분석조성병인출현술후대출혈적원인，병대원인진행통계학분석，조출가능인기대출혈발생솔증대적인소，대출혈적예방여공제제공림상삼고，병대출혈병인진행개입전새지혈적림상효과진행분석급토론。결과35례환자술후출혈량800～2700ml，평균출혈량(1200±680)ml。소유환자재출혈후，균선이확용﹑수혈﹑국부압박지혈﹑약물지혈﹑폐관등보수치료진행지혈，기중16(45.7%)례환자출혈정황득도공제，19(54.3%)례환자경긴급개입전새치료후，18례전유，기중1례인출혈량과다이전행신장절제술。결론수술전적충분준비，제고수술적숙련도，감소수술시간，급시유효적치료시방치술후대출혈적중요보장；대우출현대출혈적환자진행급시적개입전새지혈，가강저신공능수손적궤솔，시경피신경쇄석술술후대출혈적수선치료방법。
Objective This study explores the causes and treatment of massive hemorrhage after percutaneous nephrolithotomy. Methods This study chooses 35 patients as the object who are with massive hemorrhage after percutaneous nephrolithotomy and were treated in our hospital’s urinary surgery from January 2008 to January 2013. The study analyzes the causes of patients’ massive hemorrhage after the surgery. It makes the statistical analysis on the causes and finds out the factors that may cause the increase of massive hemorrhage rate. It provides clinical reference for the prevention and control of massive hemorrhage. It also analyzes the clinical effect of interventional embolization for patients who are with massive hemorrhage.Results The blood loss of the 35 patients is from 800ml to 2700ml after operation. The average blood loss is (1200±680)ml. After the hemorrhage, al patients are performed expectant treatment to stop bleeding firstly, such as dilatation, blood transfusion, local oppression hemostasis, drug hemostasis, closed tube and so on. 16 patients’(45.7%) hemorrhages are under control. 19 patients(54.3%) are performed emergency interventional embolization. Among them, 18 patients recover and 1 patient turns to be performed nephrectomy because of excessive bleeding. Conclusion There are several guarantees for massive hemorrhage after operation. First of al , the doctors ahould be ful y prepared beforeoperation and improve the operation proficiency. Besides, the operation time should be reduced. The patients must be treated timely and effectively. It can reduce the risk of impaired renal function by performing timely interventional embolization for patients who are with massive hemorrhage. It is the preferred treatment for massive hemorrhage after percutaneous nephrolithotomy.