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目的:总结选择性肾动脉栓塞术(SRAE)治疗经皮肾镜取石术(PCNL)术后严重出血的临床经验。方法:回顾性分析我院于2007年2月~2014年2月行PCNL发生术后严重出血的11例患者的临床资料和对其行SRAE的血管造影表现和疗效。结果:PCNL术后严重出血需行SRAE治疗的患者止血效果均满意,手术成功率100%;SRAE后1~3d患者肉眼血尿完全消失,血红蛋白指标上升,全身症状改善。1例SRAE后第3天出现发热、患侧腰痛症状,予对症治疗后不适消退。本组患者SRAE治疗后5d出院,随访1~6个月,术后恢复良好。结论:PCNL术后严重出血与术中动脉损伤有关,在临床操作中具有不可预见性,应严格规范PCNL的操作以减少术后严重出血的发生。术后出血严重者早期行SRAE能够达到迅速止血、尽可能保全患肾功能、有效挽救生命的诊疗效果。
Objective: To summarize the clinical experience of selective renal artery embolization (SRAE) in the treatment of severe bleeding after percutaneous nephrolithotomy (PCNL). Methods: A retrospective analysis of our hospital from February 2007 to February 2014 PCNL postoperative severe bleeding in 11 patients with clinical data and their performance of SRAE angiography and efficacy. Results: The hemostatic effect of patients undergoing severe acute bleeding after PCNL was satisfied with SRAE. The success rate of operation was 100%. The gross hematuria disappeared completely and hemoglobin index increased and the general symptoms improved after 1 ~ 3 days of SRAE. 1 case of fever on the 3rd day after SRAE, ipsilateral low back pain symptoms, symptomatic treatment to resolve the discomfort. The patients were discharged 5 days after SRAE treatment, followed up for 1 to 6 months, and recovered well. Conclusions: Serious bleeding after PCNL is related to intraoperative arterial injury. It is unpredictable in clinical practice. The operation of PCNL should be strictly regulated to reduce the incidence of severe postoperative bleeding. Serious postoperative bleeding in early SRAE can achieve rapid hemostasis, as far as possible to protect the renal function, effective treatment of life saving effect.