Meng Hongzhou, Chen Shanwen, Chen Geming, Tan Fuqing, Wang Chaojun, Shen Baihua
Department of Urology, The First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China.
Urol Int. 2013;91(3):335-9. doi: 10.1159/000350891. Epub 2013 Jul 9.
To report the incidence, risk factors, and treatments of renal subcapsular hemorrhage (RSH) complicating ureteroscopic lithotripsy (URSL).
Data from 1,918 URSLs performed between January 2004 and March 2012 were retrospectively analyzed. Patients' data included age, sex, relevant medical history, stone side, size, and degree of hydronephrosis.
All 8 patients were identified as having an RSH after URSL. There were 2 males and 6 females with a mean age of 45.6 years (range 30-62 years). The patients' relevant medical histories (renal calculi extracorporeal shock wave lithotripsy, renal operation and hypertension) were statistically different between those who did and did not develop an RSH. Acute onset of flank pain is the most common symptom. Three patients with infective and large hemorrhage were managed by percutaneous nephrostomy in 1 and percutaneous subcapsular drainage in 2. Five patients with small and uninfected hemorrhage were managed conservatively.
The rate of development of RSH complicating URSL is very low. RSH complicating URSL can occur in patients with underlying renal abnormalities. RSH is rarely associated with abrupt hemodynamic instability and usually not lethal. Treatment is selected based on the patient's hemodynamic state, infection, renal function, and the feasibility of treatment modality.
报告输尿管镜碎石术（URSL）并发肾包膜下出血（RSH）的发生率、危险因素及治疗方法。
回顾性分析2004年1月至2012年3月期间进行的1918例输尿管镜碎石术的数据。患者资料包括年龄、性别、相关病史、结石侧别、大小及肾积水程度。
8例患者在输尿管镜碎石术后被确诊为肾包膜下出血。其中男性2例，女性6例，平均年龄45.6岁（范围30 - 62岁）。发生和未发生肾包膜下出血的患者，其相关病史（肾结石体外冲击波碎石术、肾脏手术及高血压）在统计学上存在差异。突发侧腹疼痛是最常见的症状。3例感染性大出血患者中，1例行经皮肾造瘘术，2例行经皮肾包膜下引流术。5例少量非感染性出血患者采用保守治疗。
输尿管镜碎石术并发肾包膜下出血的发生率很低。输尿管镜碎石术并发肾包膜下出血可发生于有潜在肾脏异常的患者。肾包膜下出血很少与突发血流动力学不稳定相关，通常不会致命。治疗根据患者的血流动力学状态、感染情况、肾功能及治疗方式的可行性来选择。
