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

doi:10.3877/cma.j.issn.1674-3253.2021.04.018

Abstract

Abstract:

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.

Key words: Subcapsular renal hematoma, Flexible ureteroscopy, Stone, Holmium laser, Complication

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

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https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2021/V15/I04/347

Figures/Tables 4

References 22

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临床指标	患者1	患者2	患者3
性别	男	男	男
年龄(岁)	47	62	32
术侧	右	右	左
首次检查时间(d)	90	7	30
结石位置	肾盂及肾下盏	肾盂	输尿管上段
结石大小(cm×cm)	2.0×1.2	1.0×0.4	0.8×0.5
结石最大CT值(U)	1207	843	1001
术前尿路感染	是	否	否
留置双J管型号(F)	5	5	5
置管前血肌酐(μmol/L)	98	103	97
置管后血肌酐(μmol/L)	81	108	111
置管时间(d)	8	7	7
基础疾病	无	高血压病	无
其他情况	右侧重复肾畸形	左肾积水无功能	无

临床指标	患者1	患者2	患者3
性别	男	男	男
年龄(岁)	47	62	32
术侧	右	右	左
首次检查时间(d)	90	7	30
结石位置	肾盂及肾下盏	肾盂	输尿管上段
结石大小(cm×cm)	2.0×1.2	1.0×0.4	0.8×0.5
结石最大CT值(U)	1207	843	1001
术前尿路感染	是	否	否
留置双J管型号(F)	5	5	5
置管前血肌酐(μmol/L)	98	103	97
置管后血肌酐(μmol/L)	81	108	111
置管时间(d)	8	7	7
基础疾病	无	高血压病	无
其他情况	右侧重复肾畸形	左肾积水无功能	无

手术相关指标	患者1	患者2	患者3
麻醉方式	气管插管全麻	气管插管全麻	气管插管全麻
手术时间(min)	105	35	42
SRH检查方法	超声+CT	CT	CT
术前白细胞计数(10⁹/L)	7.98	6.37	13.00
术后白细胞计数(10⁹/L)	2.12	15.21	14.34
术前血红蛋白(g/L)	124	167	142
术后血红蛋白(g/L)	107	133	133
术前血肌酐(μmol/L)	81	108	111
术后血肌酐(μmol/L)	84	311	66
术后降钙素原(ng/ml)	16.74	0.13	0.08
术后血培养情况	阳性，大肠埃希菌	阴性	阴性
治疗方法	亚胺培南抗感染+卧床休息	血液透析+卧床休息	卧床休息
恢复情况	好转	好转	好转

手术相关指标	患者1	患者2	患者3
麻醉方式	气管插管全麻	气管插管全麻	气管插管全麻
手术时间(min)	105	35	42
SRH检查方法	超声+CT	CT	CT
术前白细胞计数(10⁹/L)	7.98	6.37	13.00
术后白细胞计数(10⁹/L)	2.12	15.21	14.34
术前血红蛋白(g/L)	124	167	142
术后血红蛋白(g/L)	107	133	133
术前血肌酐(μmol/L)	81	108	111
术后血肌酐(μmol/L)	84	311	66
术后降钙素原(ng/ml)	16.74	0.13	0.08
术后血培养情况	阳性，大肠埃希菌	阴性	阴性
治疗方法	亚胺培南抗感染+卧床休息	血液透析+卧床休息	卧床休息
恢复情况	好转	好转	好转

文献	SRH/FURL (例)	男/女(例)	结石位置	结石大小(cm)	手术时间(min)	术中灌注方式	SRH诊断方法	治疗方式
景超^[8]	4/500	-	肾	-	-	-	超声或CT	保守治疗
任伟等^[9]	2/287	-	肾	-	-	-	未提及	1例介入栓塞，1例穿刺引流
何跃等^[10]	1/230	-	-	-	-	手工灌注	未提及	保守治疗
李天等^[11]	18/1259	3/15	肾	2.0～4.0	126.3±22.9	手工灌注	超声及CT	11例保守治疗，5例穿刺引流
吕佳等^[12]	11/1705	3/8	肾(5)例，输尿管(6)例	1例>2，10例≤2	46.0±8.9	手工灌注	超声及CT	2例开放手术，6例保守治疗，2例穿刺引流，3例腹腔镜血肿清除手术
Watanabe等^[13]	1/-	1/-	肾盂输尿管连接部	0.5	34	灌注泵	CT	保守治疗
Xu等^[14]	1/-	-/1	肾	2.52×3.62	140	-	CT	介入栓塞
Kao等^[15]	4/45	-/4	肾	0.9～5.0	78～95	灌注泵	超声及CT	3例保守治疗，1例开放肾切除术
Nazer等^[16]	1/-	-/1	肾	2.0	88	灌注泵	CT	保守治疗

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