Zhao Yilei, Zhong Baishu, Xu Shunliang, Shen Bohua, Tan Fuqing
Department of Radiology, First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310003, China.
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Zhonghua Yi Xue Za Zhi. 2014 Aug 13;94(30):2369-71.
To explore the diagnostic and therapeutic measures of massive hemorrhage after percutaneous nephrolithotomy (PCNL) unresponsive to conservative treatment.
The clinical data of 36 cases of massive hemorrhage occurring after PCNL from January 2010 to January 2014 at our hospital were analyzed. There were 21 males and 15 females with an average age of 46.7 years. There were left (n = 22) and right (n = 14) cases. Severe hemorrhage had an average onset of Days 3-4 (range, 1 to 7) after PCNL. Clinical manifestations included a drainage of fresh red blood liquids out of kidney fistula accompanied by red gross hematuria. Conservative measures were ineffective.
On computed tomography angiography (CTA), pseudoaneurysm (n = 22) and arteriovenous fistula (n = 5) were found. Digital subtraction angiography (DSA) and coil embolization were successfully performed in 27 cases whose hemorrhage stopped in 1-3 days after embolization and kidney function returned to normal. Another 9 cases had no obvious hemorrhage on CTA. And venous hemorrhage was considered and conservative treatment succeeded.
Renal arterial CTA is an ideal for assessing massive hemorrhage after PCNL unresponsive to conservative treatment. DSA and coil embolization are the preferred treatments.
探讨经皮肾镜取石术（PCNL）后发生大量出血且保守治疗无效的诊断及治疗措施。
分析我院2010年1月至2014年1月期间36例PCNL术后发生大量出血的临床资料。其中男性21例，女性15例，平均年龄46.7岁。左侧22例，右侧14例。严重出血平均发生在PCNL术后3 - 4天（范围1至7天）。临床表现为肾造瘘管引出鲜红色血性液体并伴有肉眼血尿。保守治疗无效。
计算机断层血管造影（CTA）检查发现假性动脉瘤22例，动静脉瘘5例。27例行数字减影血管造影（DSA）及弹簧圈栓塞术，栓塞后1 - 3天出血停止，肾功能恢复正常。另外9例CTA检查未见明显出血，考虑为静脉出血，保守治疗成功。
肾动脉CTA是评估PCNL术后大量出血且保守治疗无效的理想方法。DSA及弹簧圈栓塞术是首选治疗方法。
