CAJ | 학술논문

目的：探讨PCNL术后迟发性大出血的影响因素和处理方法。方法一组364例行PCNL手术的患者中，有6例在术后3~7d出现迟发性大出血。男4例，女2例，肾脏多发性结石4例，输尿管上段结石2例，回顾性分析迟发性出血的临床表现、影响因素及治疗经验。结果数字减影血管造影(digitalsubtractionangiography，DSA）结果示：4例为假性动脉瘤，1例为假性动脉瘤合并动静脉瘘。保守治疗1例，介入栓塞治疗5例，1例行2次介入栓塞治疗。结论PCNL术后迟发性大出血比较少见，难以预料。往往与穿刺通道有关。保守治疗无效时，应该及时采用选择性动脉栓塞术治疗。
목적：탐토PCNL술후지발성대출혈적영향인소화처리방법。방법일조364례행PCNL수술적환자중，유6례재술후3~7d출현지발성대출혈。남4례，녀2례，신장다발성결석4례，수뇨관상단결석2례，회고성분석지발성출혈적림상표현、영향인소급치료경험。결과수자감영혈관조영(digitalsubtractionangiography，DSA）결과시：4례위가성동맥류，1례위가성동맥류합병동정맥루。보수치료1례，개입전새치료5례，1례행2차개입전새치료。결론PCNL술후지발성대출혈비교소견，난이예료。왕왕여천자통도유관。보수치료무효시，응해급시채용선택성동맥전새술치료。
Objectives?To?evaluate?the?affecting?factors?of?massive?delayed?hemorrhage?after?percutaneous?nephrolithotomy?(PCNL)?and?the?management?to?deal?with?this?complication.?Methods?From?2009?to?2014,364?patients?had?underwent?PCNL?for?upper?urinary?calculi,?massive?delayed?hemorrhage?occurred?in?6?of?them,?4?males?and?2?females,?Clinical?manifestation,?Affecting?factors?and?treatment?experience?of?massive?delayed?hemorrhage?after?PCNL?were?retrospectively?analysised?according?to?these?cases.?Results?The?results?of?digital?subtraction?angiography?showed?that?renal?pseudoaneurysm?(RAP)?in?4?cases,?RAP?combined?with?renal?arteriovenous?fistula?(RAVF)?in?1?case.?1?case?were?successfully?managed?with?conservative?treatment?and?the?hematuria?resolved.?5?cases?were?treated?with?selective?renal?arterial?embolization,?with?complete?resolution?of?haemorrhage,?no?further?clinical?deterioration,?and?preservation?of?renal?functionl?of?the?5?cases?underwent?repeat?angiography?and?embolization?of?the?lesion.?Conclusions?Massive?delayed?hemorrhage?after?PCNL?is?a?rare?and?unpredictable?complication?of?percutaneous?nephrolithotripsy,this?complication?is?generally?associated?with?the?nephrostomy?tract,when?conservative?treatment?is?inefficacy,?selective?renal?arterial?embolization?should?be?performed?timely.