Application of minimally invasive technique of percutaneous nephroscope in the treatment of perirenal hematoma
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摘要: 目的 探讨经皮肾镜联合超声负压吸引术治疗症状性肾周血肿的有效性和安全性。方法 回顾性分析2013年1月—2022年5月浙江省人民医院收治的12例肾周血肿患者的病例资料。男7例，女5例；平均年龄49(24~61)岁。血肿位于左侧8例，右侧4例。血肿最大径平均12.5(9.3~20.4) cm。患者均有发热、腰痛症状，伴有腹胀2例。合并高血压2例。2例为外伤后肾破裂肾周血肿，1例为体外冲击波碎石术后肾周血肿，4例为输尿管软镜术后肾周血肿，4例为经皮肾镜术后肾周血肿，1例为输尿管镜下输尿管支架置入术后肾周血肿。12例均由单术者行局部麻醉下经皮肾镜联合超声负压吸引术。分析手术时间、术后引流管留置时间、术后住院时间、治疗效果及并发症情况。结果 12例手术均顺利完成，其中单通道10例，双通道2例。手术时间平均48(20~85) min，术后引流管留置时间平均9(4~15) d，术后住院时间平均6(5~10) d。出院前复查CT均显示肾周血肿明显缩小甚至基本消失。术中、术后均无严重并发症。术后随访时间平均5(3~12)个月，均无复发。结论 经皮肾镜联合超声负压吸引术是治疗症状性肾周血肿安全、有效的手术方式之一。Abstract: Objective To evaluate the efficacy and safety of ultrasound negative pressure suction with percutaneous nephroscope in the treatment of symptomatic perirenal hematoma.Methods The clinical data of 12 patients with perirenal haematoma admitted to Zhejiang Provincial People's Hospital from January 2013 to May 2022 were retrospectively analyzed. There were 7 males and 5 females. The average age was 49(24-61) years. The haematoma was located on the left side in 8 cases and on the right side in 4 cases. The average maximum diameter of haematoma was 12.5(9.3-20.4) cm. All patients had fever and low back pains, accompanied by abdominal distention in 2 cases. There were 2 cases with hypertension. Two cases were perirenal hematoma after traumatic renal rupture, 1 case was perirenal hematoma after extracorporeal shock wave lithotripsy, 4 cases were perirenal hematoma after flexible ureteroscopy, and 4 cases were perirenal hematoma after percutaneous nephroscopy, 1 case was perirenal hematoma after double J ureteral stent implantation under ureteroscope. All patients were treated with ultrasound negative pressure suction with percutaneous nephroscope under local anesthesia by single operator. The operation time, drainage tube indwelling time, postoperative hospital stay, therapeutic effect and complications were analyzed.Results All operation procedures of 12 patients were successfully completed, including 10 cases of single channel, 2 cases of double channels. The average operation time was 48(20-85) min, the average indwelling time of drainage tube was 9(4-15) d, and the average hospitalization time was 6(5-10) d. Before discharge, CT reexamination showed that the perirenal haematoma was significantly reduced or even basically disappeared. There were no serious complications during and after operation. The average follow-up time was 5(3-12) months. There was no recurrence in all patients.Conclusion Percutaneous nephroscope combined with ultrasound negative pressure suction is one of the safe and effective surgical methods for the treatment of symptomatic perirenal hematoma.
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Key words:
- perirenal haematoma /
- percutaneous nephroscope /
- minimally invasive technique /
- treatment
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