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目的:探讨经皮穿刺置管引流和尿激酶局部注射治疗经皮肾镜术后肾包膜下巨大血肿的价值。方法:经皮肾镜术后形成肾包膜下巨大血肿16例,出血停止1～3周后,在B超定位下行经皮血肿穿刺置管引流术,引流出陈旧性积血后,每间隔2～3d,通过引流管分别向血肿内注射3万U的尿激酶并保留24h,然后充分引流。结果:经皮穿刺置管引流陈旧性积血后,间断注射尿激酶溶解血块,30～35天后复查CT显示血肿明显减小,仅为治疗前的1/19～1/56。16例患者经1～2年随访,无继发性出血、感染、高血压等并发症。结论:对经皮肾镜术后肾包膜下巨大血肿患者行经皮血肿穿刺置管引流,同时应用尿激酶局部注射溶解血凝块,可有效溶解引流肾包膜陈旧性出血和血凝块,具有推广价值。
Objective: To investigate the value of percutaneous nephrolithotomy and percutaneous nephrolithotomy for the treatment of huge subrenal hematoma by percutaneous catheter drainage and urokinase local injection. Methods: Percutaneous nephrolithotomy resulted in the formation of giant renal hematoma in 16 cases. After the bleeding stopped for 1 to 3 weeks, the percutaneous hematoma was punctured and catheterized under B ultrasound. After drainage of the old hemorrhage, 2 ~ 3d, respectively, through the drainage tube into the hematoma 30 000 U of urokinase and retained 24h, and then fully drainage. Results: Percutaneous catheter drainage of old hemorrhage, intermittent injection of urokinase dissolved blood clots, 30 to 35 days after the review of CT showed hematoma significantly reduced, only 1/19 ~ 1 / 56.16 before treatment of patients 1 to 2 years follow-up, no secondary bleeding, infection, hypertension and other complications. Conclusion: Percutaneous nephrolithotomy in patients with giant renal subcapsular hematoma underwent percutaneous hematoma drainage catheter drainage, while the application of local injection of urokinase dissolved blood clots can effectively dissolve the drainage of renal capsule hemorrhage and blood clots, With promotional value.