Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, #59 Liuting Street, Ningbo City, 315010, Zhejiang Province, China.
School of Medicine, Ningbo University, No.818 Fenghua Road, Ningbo City, 315000, Zhejiang Province, China.
BMC Surg. 2022 Mar 23;22(1):108. doi: 10.1186/s12893-022-01561-8.
Acute pulmonary embolism and severe renal bleeding are two lethal postoperative complications, but there has been no report that involves both of them after mini-percutaneous nephrolithotomy.
A 62-year-old woman was admitted to our hospital with extremely severe hydronephrosis and multiple right renal calculi. After thorough examination, she received prone-position mini-percutaneous nephrolithotomy under spinal anaesthesia. Three days postoperatively, the patient complained of chest pain and dyspnea. Computed tomography pulmonary angiogram (CTPA) showed multiple embolisms in the left pulmonary artery and its branches. Symptoms were relieved after anticoagulant and thrombolysis therapy. On the 6th postoperative day, the patient developed shortness of breath, computed tomography angiography (CTA) showed massive hemorrhage in the right kidney, diffused contrast medium in the middle and lower part of the right kidney was seen during digital substraction angiography (DSA). Superselective right renal artery embolization (SRAE) was then applied using coil to occlude the responsible artery. The patient generally recovered under conscientious care and was approved to be discharged 26 days postoperatively.
This is the first case that involved both acute pulmonary embolism and severe post thrombolysis renal bleeding. The importance of D-dimer in the prediction and early detection of pulmonary embolism should be noted. For post thrombolysis renal bleeding, SRAE is considered as a reliable treatment.
急性肺栓塞和严重肾出血是两种致命的术后并发症，但尚未有经皮肾镜碎石术后同时发生这两种并发症的报道。
一名 62 岁女性因重度肾积水和多发右肾结石入院。经全面检查后，患者在椎管内麻醉下行俯卧位微创经皮肾镜碎石术。术后 3 天，患者诉胸痛、呼吸困难。肺部计算机断层血管造影（CTPA）显示左肺动脉及其分支多发栓塞。经抗凝溶栓治疗后症状缓解。术后第 6 天，患者出现呼吸急促，CT 血管造影（CTA）显示右肾大量出血，数字减影血管造影（DSA）见右肾中下部弥散性造影剂。随后采用弹簧圈行超选择性右肾动脉栓塞术（SRAE）闭塞责任动脉。经精心护理，患者一般情况恢复良好，术后 26 天获准出院。
这是首例同时发生急性肺栓塞和溶栓后严重肾出血的病例。应注意 D-二聚体在预测和早期发现肺栓塞中的重要性。对于溶栓后肾出血，SRAE 被认为是一种可靠的治疗方法。
