Kessaris D N, Bellman G C, Pardalidis N P, Smith A G
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York.
J Urol. 1995 Mar;153(3 Pt 1):604-8. doi: 10.1097/00005392-199503000-00011.
Renal hemorrhage is the most worrisome complication of percutaneous renal surgery. Between August 1983 and August 1992 we performed 2,200 percutaneous renal operations, with 17 patients (0.8%) requiring angiography and embolization for significant bleeding uncontrolled by the usual measures. The angiographic diagnoses were arteriovenous fistula in 7 patients, pseudoaneurysm in 4, fistula and pseudoaneurysm in 2, and lacerated renal vessels in 2. A total of 15 patients required no further treatment after embolization, while 2 underwent either partial nephrectomy or open exploration. No risk factors for hemorrhage could be identified. We recommend angiography and embolization under 3 conditions; 1) in the immediate postoperative period when clamping of the nephrostomy tube and a tamponade balloon catheter fail to control hemorrhage (24% of our series), 2) in the early postoperative period (2 to 7 days) when the patient requires 3 or 4 units of blood after replacement of the initial blood loss (41% of our series) and 3) for sudden hemorrhage more than 7 days postoperatively (35% of our series).
肾出血是经皮肾手术最令人担忧的并发症。1983年8月至1992年8月期间，我们进行了2200例经皮肾手术，其中17例患者（0.8%）因常规措施无法控制的严重出血而需要进行血管造影和栓塞治疗。血管造影诊断结果为：7例患者为动静脉瘘，4例为假性动脉瘤，2例为瘘合并假性动脉瘤，2例为肾血管撕裂伤。15例患者在栓塞治疗后无需进一步治疗，而2例患者接受了部分肾切除术或开放探查术。未发现出血的危险因素。我们建议在以下3种情况下进行血管造影和栓塞治疗：1）术后即刻，当夹闭肾造瘘管和使用填塞球囊导管无法控制出血时（我们系列中的24%）；2）术后早期（2至7天），当患者在补充初始失血量后需要3或4单位血液时（我们系列中的41%）；3）术后7天以上突然出血时（我们系列中的35%）。
