Department of Obstetrics and Gynecology Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
BJU Int. 2012 Apr;109(8):1230-4. doi: 10.1111/j.1464-410X.2011.10490.x. Epub 2011 Aug 24.
To report the incidence, risk factors, and outcomes of subcapsular renal haematoma (SRH) after ureteroscopic lithotripsy (URSL) using holmium:yttrium-aluminum-garnet (Ho:YAG) laser to treat ureteric stones.
Prospective data from 2848 URSLs performed between January 2003 and September 2010 were retrospectively analysed. In all 11 patients were identified as having a SRH after URSL if they had persistent severe ipsilateral flank pain or a palpable mass within a day of surgery, or presented with radiographic evidence of a SRH. Risk factors for the development and course of the SRH were reported.
Of the 2848 consecutive patients treated with URSL using Ho:YAG laser, 11 (0.4%) developed a SRH after surgery. Patients who developed a SRH had larger stones (1.4 vs 0.9 cm, P < 0.001), more severe ipsilateral hydronephrosis (P < 0.001), longer operation duration (41 vs 33 min, P < 0.001), and higher perfusion pressure of hydraulic irrigation (176.8 vs 170.2 mmHg, P < 0.001) than patients who did not develop a SRH. Patient age, sex, body mass index, presence of diabetes mellitus, history of urolithiasis and hypertension, presence of multiple stones, stone location and flow rate of hydraulic irrigation were not statistically different in patients who did or did not develop a SRH. Most patients were managed conservatively, with no further intervention or with a flank drain, until the SRH resolved. Overall, in three patients the SRH resolved with no further intervention, six patients were treated with a drain only, and two patients had open surgery within a day of presenting with SRH.
The rate of development of SRH after URSL is very low. Most patients who present with a SRH after URSL, can be treated conservatively with no intervention or with a drain only.
报告经输尿管镜钬激光碎石术（URSL）治疗输尿管结石后发生包膜下肾血肿（SRH）的发生率、危险因素和结局。
回顾性分析 2003 年 1 月至 2010 年 9 月期间行 2848 例 URSL 的前瞻性数据。如果患者在术后 1 天内出现持续性严重同侧腰痛或可触及的肿块，或出现 SRH 的放射影像学证据，则认为所有患者均发生了 SRH。报告了发生 SRH 的危险因素及其病程。
在接受钬激光 URSL 治疗的 2848 例连续患者中，有 11 例（0.4%）术后发生 SRH。发生 SRH 的患者结石更大（1.4 厘米比 0.9 厘米，P<0.001），同侧肾积水更严重（P<0.001），手术时间更长（41 分钟比 33 分钟，P<0.001），液压冲洗的灌注压更高（176.8 毫米汞柱比 170.2 毫米汞柱，P<0.001）。与未发生 SRH 的患者相比，患者年龄、性别、体重指数、是否患有糖尿病、是否有尿路结石和高血压史、是否存在多发性结石、结石位置和液压冲洗流速无统计学差异。大多数患者接受了保守治疗，无需进一步干预或仅使用侧引流管，直到 SRH 消退。总体而言，有 3 例 SRH 无需进一步干预即自行消退，6 例仅接受引流管治疗，2 例在出现 SRH 后 1 天内接受了开放手术。
URSL 后发生 SRH 的发生率非常低。大多数在 URSL 后出现 SRH 的患者可通过保守治疗，无需干预或仅使用引流管进行治疗。
