Nedjim Saleh Abdelkerim, Berdé Hissein Hagguir, Kbirou Adil, Moataz Amine, Dakir Mohamed, Debbagh Adil, Aboutaieb Rachid
Urology Department, CHU Ibn Rochd, Casablanca 20100, Morocco.
J Surg Case Rep. 2024 Mar 21;2024(3):rjae177. doi: 10.1093/jscr/rjae177. eCollection 2024 Mar.
Percutaneous nephrolithotomy has become the standard procedure for the management of large kidney stones. Compared with other endo-urological techniques, it has a better fragmentation rate in a single session for kidney stones over 20 mm. It is therefore the recommended first-line treatment modality for large kidney stones. Bleeding is a well-known complication of this procedure, often requiring transfusion. In 0.8% of cases, bleeding can be severe, requiring surgical intervention to control hemostasis. Damage to the lumbar artery is a very rare event, and a potential complication. To our knowledge, this is the first report of lumbar artery involvement during percutaneous nephrolithotomy, complicated by severe bleeding and hemodynamic instability, necessitating conversion. Surgical exploration revealed a severed and bleeding lumbar artery. After hemostasis control by coagulation and ligation, the patient became stable. The patient was discharged on D3, where ureteroscopic lithotripsy was planned after collegial discussion with the patient. Based on this experience, it is important for the surgeon to have in mind certain principles and a thorough knowledge of the classic lateral lumbotomy approach to the kidney.
经皮肾镜取石术已成为治疗大型肾结石的标准手术。与其他腔内泌尿外科技术相比，对于直径超过20毫米的肾结石，它在单次手术中的碎石率更高。因此，它是大型肾结石推荐的一线治疗方式。出血是该手术一种众所周知的并发症，常常需要输血。在0.8%的病例中，出血可能很严重，需要手术干预来控制止血。腰动脉损伤是非常罕见的事件，也是一种潜在的并发症。据我们所知，这是第一例经皮肾镜取石术期间腰动脉受累的报告，伴有严重出血和血流动力学不稳定，需要转为开放手术。手术探查发现腰动脉断裂并出血。通过凝血和结扎控制止血后，患者病情稳定。患者于术后第3天出院，经与患者共同商讨后计划进行输尿管镜碎石术。基于这一经验，外科医生牢记某些原则并全面了解经典的经腰侧入路肾脏手术方法非常重要。
