摘要
目的探讨输尿管镜碎石术处理输尿管结石后发生迟发肾包膜下血肿的诊断和治疗方法以及发生的有关因素。方法回顾性分析2015年1月~2018年10月行输尿管镜碎石术后发生迟发肾包膜下血肿3例患者的病例资料,评估其一般情况、手术情况和肾包膜下血肿诊断和治疗情况。结果3例输尿管结石患者行输尿管镜碎石术,手术顺利,手术时间少于30min,全部留置F5输尿管支架,术后依据药物敏感试验使用有效抗生素,术后复查双肾超声和腹部平片未见异常,病情稳定后出院。出院后1周以上,在无诱因下出现腰腹部疼痛伴畏寒发热,CT检查提示肾包膜下血肿,在1%利多卡因局部麻醉下行经皮包膜下血肿穿刺置管引流术,使用有效抗生素治疗后患者痊愈。结论输尿管镜术处理输尿管结石后可以发生迟发肾包膜下血肿,感染没有控制或者感染加剧是其发生的主要因素,经皮包膜下血肿穿刺置管引流术是最有效的治疗方法。
Objective To explore the diagnosis and treatment of delayed renal subcapsular hematoma after ureteroscopic lithotripsy for ureteral calculi and related factors. Methods Case data of 3 patients with delayed renal subcapsular hematoma after ureteroscopic lithotripsy from January 2015 to October 2018 were retrospectively analyzed.The general situation,operative situation and diagnosis and treatment of subcapsular hematoma were evaluated. Results Ureteroscopic lithotripsy was performed successfully in 3 cases with ureteral calculi and the operation time was less than 30 minutes.All patients were indwelled with F5 ureteral stent and effective antibiotics were used according to drug sensitivity test after surgery.Postoperative re-examination of double kidney ultrasound and abdominal plain film showed no abnormalities and the patients were discharged after stable condition.More than 1 week after discharge,there was lumbar and abdominal pain accompanied by aversion to cold and fever without inducement.CT examination suggested subcapsular hematoma.The patients underwent percutaneous subcapsular hematoma puncture drainage under local anesthesia with 1% lidocaine and the patients recovered after treatment with effective antibiotics. Conclusion Uncontrolled infection or increased infection is the main cause for the occurrence of delayed renal subcapsular hematoma after ureteroscopic lithotripsy for ureteral calculi.Percutaneous subcapsular hematoma puncture drainage is the most effective treatment.
作者
刘克龙
陈海峰
刘家驹
何健鸿
LIU Kelong;CHEN Haifeng;LIU Jiaju;HE Jianhong(Department of Urology,Chencun Hospital Affiliated to Shunde Hospital of Southern Medical University,Foshan 528313,China)
出处
《中国医药科学》
2019年第15期219-224,共6页
China Medicine And Pharmacy
关键词
输尿管镜碎石术
迟发肾包膜下血肿
经皮包膜下血肿穿刺引流术
Ureteroscopic lithotripsy
Delayed renal subcapsular hematoma
Percutaneous subcapsular hematoma puncture drainage
