Davidoff R, Bellman G C
Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California, USA.
J Urol. 1997 Apr;157(4):1229-31.
Renal hemorrhage is one of the most common and worrisome complications of percutaneous renal surgery. We studied the incidence of renal hemorrhage and transfusion rates in patients undergoing balloon or Amplatz fascial dilation of the nephrostomy tract.
Medical records of 143 patients who underwent 150 percutaneous renal procedures, including percutaneous nephrolithotomy, antegrade endopyelotomy and percutaneous treatment of stones in caliceal diverticula, were reviewed. The nephrostomy tract was dilated with balloon (50 patients) or Amplatz sequential (100) dilators. Perioperative decreases in hemoglobin level and blood transfusion rates were compared between the 2 groups.
Of the 100 patients undergoing percutaneous renal Amplatz dilation 25 (25%) required a blood transfusion, compared to only 5 of 50 (10%) undergoing balloon dilation. The difference in the transfusion rates between the 2 groups was statistically significant (p = 0.048).
Improvements in the technique of percutaneous renal surgery have decreased the morbidity associated with these procedures. In our study use of balloon tract dilators led to less renal hemorrhage and lower transfusion rates compared to Amplatz dilation. Additionally, balloon dilation appears to be more rapid and avoids renal movement away from the surgeon, which occasionally occurs during Amplatz dilation.
肾出血是经皮肾手术最常见且令人担忧的并发症之一。我们研究了接受肾造瘘通道球囊扩张或安普拉斯筋膜扩张的患者的肾出血发生率及输血率。
回顾了143例患者的医疗记录，这些患者接受了150例经皮肾手术，包括经皮肾镜取石术、顺行肾盂内切开术以及肾盂憩室结石的经皮治疗。肾造瘘通道用球囊（50例患者）或安普拉斯顺序扩张器（100例患者）进行扩张。比较两组患者围手术期血红蛋白水平的下降情况及输血率。
在100例接受经皮肾安普拉斯扩张的患者中，25例（25%）需要输血，而在50例接受球囊扩张的患者中只有5例（10%）需要输血。两组输血率的差异具有统计学意义（p = 0.048）。
经皮肾手术技术的改进降低了这些手术相关的发病率。在我们的研究中，与安普拉斯扩张相比，使用球囊通道扩张器导致的肾出血更少，输血率更低。此外，球囊扩张似乎更快，且可避免在安普拉斯扩张期间偶尔出现的肾脏与术者的移位。
