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目的:探讨微创经皮肾镜取石术(MPCNL)后迟发性大出血的处理方法。方法:回顾性分析我院2006~2012年采用MPCNL后发生迟发性大出血患者的临床资料:严重迟发性大出血15例,男9例,女6例,出血时间为术后3~15d,出血持续时间为2~12d;失血量200~2 000ml,平均600ml。8例夹闭肾造瘘管,给予制动卧床、补液扩容、止血、抗感染等对症治疗;2例拔除肾造瘘管过程中出血,重新插入肾造瘘管压迫止血,1个月后拔除肾造瘘管;5例行超选择性肾动脉栓塞治疗,其中1例治疗失败改行肾切除术。结果:本组15例患者随访半年,未见再次出血,肾功能良好。结论:MPCNL术后迟发性大出血一般可经保守治愈;对于严重出血者,可行超选择性肾动脉栓塞治疗,效果良好。
Objective: To explore the treatment of delayed major bleeding after minimally invasive percutaneous nephrolithotomy (MPCNL). Methods: The clinical data of patients with delayed major bleeding after MPCNL in our hospital from 2006 to 2012 were analyzed retrospectively: 15 cases were severe and delayed major hemorrhage, 9 were males and 6 were females, the bleeding time was 3 ~ 15 days after operation, bleeding Duration of 2 ~ 12d; blood loss 200 ~ 2 000ml, an average of 600ml. 8 cases of renal fistula occlusion, giving brake ambulation, rehydration expansion, hemostasis, anti-infection and other symptomatic treatment; 2 cases of removal of renal fistula bleeding during re-insertion of renal fistula to stop bleeding, remove the renal fistula after 1 month ; 5 cases of super-selective renal artery embolization, including 1 case of failure to divert nephrectomy. Results: The group of 15 patients were followed up for six months, no bleeding again, renal function is good. CONCLUSION: Delayed major hemorrhage after MPCNL can be cured by conservative treatment. For severe bleeding, it is feasible to perform super-selective renal artery embolization.