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目的:总结微通道经皮肾镜取石术后症状性肾周血肿的诊治方法。方法:回顾性分析15例行微通道经皮肾镜取石术后出现症状性肾周血肿患者的临床资料,总结其治疗措施和结果。结果:15例患者经B超检查发现肾周血肿,13例再行CT检查确诊。血肿部位:肾脏后外侧13例、肾脏下极及腹侧2例。血肿深度1.8~8.2 cm(平均3.6 cm)。4例患者经单纯药物治疗3~10 d后,血肿相关临床症状逐渐消失。3例行血肿穿刺抽液,4~7 d后相关症状逐渐消失;6例行血肿穿刺抽液并置管引流,其中5例引流3~7 d后,患者临床症状得以控制并拔除引流管,1例感染症状持续存在,最终行开放手术清除血肿;3例行开放手术清除血肿,7~10 d后逐渐痊愈。获得血肿液体样本11例,其中合并细茵感染者4例。结论:对于微通道经皮肾镜取石术后症状性肾周血肿,及时诊断后采用恰当的药物治疗或联合外科处理能取得较好的疗效。
Objective: To summarize the diagnosis and treatment of symptomatic perinephric hematoma after micro-channel percutaneous nephrolithotomy. Methods: The clinical data of 15 patients with symptomatic perinephric hematoma after micro-channel percutaneous nephrolithotomy were retrospectively analyzed, and the treatment measures and results were summarized. Results: Peripheral hematoma was found in 15 cases by B-mode ultrasound, and CT scan was performed in 13 cases. Hematoma site: 13 cases of posterior lateral kidney, 2 cases of inferior kidney and ventral. Hematoma depth 1.8 ~ 8.2 cm (average 3.6 cm). 4 patients after simple drug treatment 3 ~ 10 d, hematoma-related clinical symptoms gradually disappear. 3 cases of hematoma puncture fluid, 4-7 days after the relevant symptoms gradually disappear; 6 cases of hematoma puncture fluid drainage and drainage, of which 5 cases of drainage 3 ~ 7 d after the clinical symptoms of patients and removal of the drainage tube, One patient had persistent symptoms of infection, finally cleared the hematoma by open surgery. Three patients underwent open surgery to clear the hematoma and recovered gradually after 7 to 10 days. Hematoma liquid samples were obtained in 11 cases, of which 4 cases were complicated with microinvasions. Conclusion: For percutaneous nephrolithotomy after percutaneous nephrolithotomy, symptomatic perinephric hematoma can be obtained after timely diagnosis by appropriate medication or surgical treatment.