CAJ | 학술논문

目的：分析经皮肾镜碎石取石术（ percutaneous nephrolithotomy， PCNL ）出血并发症急诊处理的治疗效果。方法回顾性分析经皮肾镜碎石取石术治疗上尿路复杂性结石3286例的临床资料。结果该组3286例患者，27例并发明显出血（0．82％）。出血原因主要为穿刺道选择不理想，有17例（62．96％）。术中出血13例，术后出血14例，反复迟发性出血3例；全组输血共7例，占25．93％（7／27）；无中转开放手术及行肾切除病例；24例经局部压迫、输血、抗炎、利尿、止血、绝对卧床休息等治疗痊愈，3例急诊行超选择肾动脉栓塞术治愈。结论经皮肾镜碎石取石术出血是一种少见且难以预测的并发症，可危及生命需急诊处理，准确判断出血的原因并掌握术中预防出血的操作方法可使其并发症风险明显降低。术后反复出血首先应考虑肾迟发性出血的可能，急诊行超选择性肾动脉栓塞术是解决此类出血并发症安全、有效的方法。
목적：분석경피신경쇄석취석술（ percutaneous nephrolithotomy， PCNL ）출혈병발증급진처리적치료효과。방법회고성분석경피신경쇄석취석술치료상뇨로복잡성결석3286례적림상자료。결과해조3286례환자，27례병발명현출혈（0．82％）。출혈원인주요위천자도선택불이상，유17례（62．96％）。술중출혈13례，술후출혈14례，반복지발성출혈3례；전조수혈공7례，점25．93％（7／27）；무중전개방수술급행신절제병례；24례경국부압박、수혈、항염、이뇨、지혈、절대와상휴식등치료전유，3례급진행초선택신동맥전새술치유。결론경피신경쇄석취석술출혈시일충소견차난이예측적병발증，가위급생명수급진처리，준학판단출혈적원인병장악술중예방출혈적조작방법가사기병발증풍험명현강저。술후반복출혈수선응고필신지발성출혈적가능，급진행초선택성신동맥전새술시해결차류출혈병발증안전、유효적방법。
Objective To analyze the emergency treatment effect of bleeding complications in percutaneous nephrolithotomy. Methods Clinical data of 3286 patients with ureteral stones treated by percutaneous nephrolithotomy were retrospectively analyzed. Results A total of 27 patients (0.82%) complicated with bleeding among 3286 patients.The major reason of bleeding complications was unideal puncturing tract, 17 cases were included (62.96%).13 patients bled during the operation, 14 patients happened postopera-tively, and 3 patients were repeatedly delayed hemorrhage.7 patients were treated with blood transfusion, accounting for 25.93% (7/27).No percutaneous nephrolithotomy conversion to open operation and nephretomy happened.24 patients with bleeding complication healed through local oppression, blood transfusion, anti-inflammatory, diuresis, hemostasis, and absolute rest in bed, while the other three patients with super-selective renal arterial embolization.Conclusions Bleeding complication in percutaneous nephrolithotomy is rare but difficult to predict, which can be life-threatening and need emergency treatment, the accurate judgment of the cause for bleeding and mastery of the operation methods for prevention can significantly decrease its risk.Renal delayed hemorrhage should be considered first in repeated postoperative bleeding, and emergent super-selective renal artery embolization is the safe and effective solution.