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中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 347 -351. doi: 10.3877/cma.j.issn.1674-3253.2021.04.018

病例研究

输尿管软镜钬激光碎石术后肾包膜下血肿三例报告并文献复习
朱蜀侠1, 李康1,(), 王宇1, 袁丹1, 刘东亮1   
  1. 1. 610041 四川,西南医科大学附属成都三六三医院泌尿外科
  • 收稿日期:2020-05-07 出版日期:2021-08-01
  • 通信作者: 李康
  • 基金资助:
    2017年成都市卫计委课题(2017068)

Clinical analysis of subcapsular renal hematoma after flexible ureteroscopic holmium laser lithotripsy

Shuxia Zhu1, Kang Li1,(), Yu Wang1, Dan Yuan1, Dongliang Liu1   

  1. 1. Department of Urology, Chengdu 363 Hospital Attached to Southwest Medical University, Sichuan 610041, China
  • Received:2020-05-07 Published:2021-08-01
  • Corresponding author: Kang Li
引用本文:

朱蜀侠, 李康, 王宇, 袁丹, 刘东亮. 输尿管软镜钬激光碎石术后肾包膜下血肿三例报告并文献复习[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(04): 347-351.

Shuxia Zhu, Kang Li, Yu Wang, Dan Yuan, Dongliang Liu. Clinical analysis of subcapsular renal hematoma after flexible ureteroscopic holmium laser lithotripsy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(04): 347-351.

目的

探讨输尿管软镜钬激光碎石术后肾包膜下血肿的危险因素、诊断及治疗方法。

方法

回顾性分析3例输尿管软镜钬激光碎石术后肾包膜下血肿的临床资料并进行文献复习。

结果

3例患者术后均出现患侧腰背部疼痛,1例患者出现急性肾功能不全,1例患者出现尿源性脓毒血症。3例患者均经CT确诊肾包膜下血肿。2例患者采取保守治疗,1例患者行血液透析治疗,3例患者均治疗好转出院。

结论

肾包膜下血肿是输尿管软镜钬激光碎石术少见且较为严重的并发症,与患者肾脏病理学改变、术前感染情况、术中术后肾盂压力剧烈波动等有关,术前术中应控制其危险因素,降低其发生率,一旦发生,应早发现早治疗,避免出现严重后果。

Objective

To investigate the risk factors, diagnosis and treatment of subcapsular renal hematoma after flexible ureteroscopic holmium laser lithotripsy.

Methods

The clinical data of 3 cases of subcapsular renal hematoma after flexible ureteroscopic holmium laser lithotripsy were retrospectively analyzed. Besides, the literatures were reviewed.

Results

Postoperative lumbago and hematuria occurred in 1 case, postoperative lumbago, hematuria and acute renal insufficiency occurred in 1case, 1 case developed into uro sepsis, lumbago and hematuria after operation. Subcapsular renal hematoma was diagnosed by CT in 3 cases. 2 cases were treated conservatively, and 1 case was treated with hemodialysis, All cases recovered after treatment.

Conclusion

Subcapsular reanl hematoma after flexible ureteroscopic holmium laser lithotripsy is a rare but serious complication of flexible ureteroscopy, which is involved with the pathological changes of kidney, preoperative infection, intraoperative and postoperative renal pelvic pressure dramatic changes. Preoperative and intraoperative control of risk factors should carry out to reduce incidence. Once it happens, early diagnosis and early treatment should be made for avoiding serious consequences.

表1 三例输尿管软镜术后肾包膜下血肿患者的临床资料
图3 肾包膜下血肿患者3 CT图像对比(图3a为术后1 d,图3b为术后1个月)
表2 3例患者手术相关指标
表3 输尿管软镜术(FURL)后发生肾包膜下血肿(SRH)文献总结
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