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Objective To investigate the causes of bleeding due to arterial injury after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods We retrospectively analyzed the clinical data of 2 980 patients who underwent ultrasound-guided mPCNL between January 2012,and January 2017,in our hospital.Among them,1 853 were male and 1 127 were female.Age from17 to 76 years old,average age was (45.7 ± 24.1) years.The calculi size was from 1.5 to 4.2 cm,average of (2.62 ± 1.08) cm.There were 2 478 kidney stones and 502 cases of ureteral calculi.Besides,727 cases with mild hydronephrosis,1 971 cases with moderate hydronephrosis,282 cases with severe hydronephrosis;480 patients with urinary tract infection;103 patients with renal empyema or acute renal failure;63 patients with cardiovascular and cerebrovascular stent implantation;214 patients with diabetes mellitus.Results In this study,all of the patients were established percutaneous renal tract successfully,indwelling drainage tube (6 ± 2)d,and postoperative hemorrhage in 117 cases,of which 29 patients suffered from bleeding due to arterial injury and DSA showed 20 cases with acute arterial injury,5 cases with pseudo-aneurysm,and 4 cases with arteriovenous fistula.However,all these cases were rehabilitated after the treatment of super-selective renal artery embolization.The rates of arterial injury of renal calyx access and pelvic access were 0.39％ (10/2 535) and 4.27％ (19/445),respectively.The rate of arterial injury in renal pelvic access was significantly higher than renal calyx access of PCNL (P ＜ 0.05).The rates of arterial injury in lower,middle,upper calyx access were 0.38％ (1/267),0.40％ (6/1 516),0.40％ (3/752),respectively.There was no significant effect of different renal calyx on postoperative arterial injury rate of mPCNL(P ＞0.05).All the percutaneous renal accesses were dilated with Amplatz sheaths,and the arterial injury rate of F16-18 and F20-22 tracts in the calyx access were 0.35％ (5/1 446),0.46％ (5/1 089),respectively,with no significant difference in size of calyx access associated with rate of arterial injury after mPCNL(P ＞0.05).The arterial injury rates of F16-18 and F20-22 tracts in the pelvic access were 1.98％ (5/253) and 7.29％ (14/192),respectively.There was significant difference in the size of the pelvic access in the rate of arterial injury after mPCNL(P ＜ 0.05).In addition,the arterial injury rate of single tract PCNL was 0.94％ (25/2 653) as compared to 1.22％ (4/327) in multi-tracts PCNL.There was no significant difference in the rate of arterial injury between single and multi-tracts PCNL(P ＞ 0.05).Conclusions The puncture of the renal pelvis and size of renal pelvis tract significantly increased the probability of postoperative bleeding due to arterial injury.
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Objective To evaluate the clinical application of high quality for super-selective renal artery embolization (SRAE) in treating bleeding after percutaneous nephrolithotomy (PCNL).Methods 134 patients received percutaneous nephrolithotomy were divided into control group (67 patients) and observation group (67 patients).All of patients with serious bleeding after PCNL were given SRAE in the Second Affiliated Hospital of Kunming Medical College from June 2010 to June 2015.At the same time,we gave high quality nursing to observation group.The patients in control group received routine nursing.The effect of nursing was observed.Results The degree of hematuria disappear of the patients in observation group was higher than that in control group (P＜ 0.05).There were fewer complications in observation group.In the sixth month after discharge,none of them had obvious renal impairment.No recurrence of hematuria,pus kidney and urinary cyst was tested.All cases were satisfied with the treatment.Conclusion It's the key to prevent serious complications and cure successfully with effective and timely supervision and high quality nursing care during the perioperation of SRAE in treating bleeding after PCNL.
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Objective To investigate the clinical effect of interventional embolization in the treatment of intractable hematuria after percutaneous nephrolithotripsy. Methods A retrospective analysis of the First Affili?ated Hospital of Kunming Medical University from February 2014 to March 2016 after percutaneous nephrolithot?omy appears intractable hematuria patients in 36 cases was conducted. All patients were treated with conservative treatment but invalid,then lesion was confirmed by renal artery angiography,after that,line embosphere micro?spheres or polyvinyl alcohol particles combined with spring ring interventional the treatment was conduc?ted. Postoperative urine color changes, postoperative complications and follow?up were observed whether have bleeding again. Results ( 1) The success rate:36 cases patients all with successful embolization,the symptoms of hematuria in 1?3 days gradually disappeared,and the effective rate was 100%. ( 2) Complications:the compli?cations after operation in 10 patients appeared different degree of embolism syndrome,given analgesic and antie?metic,the symptoms gradually ease after treatment. One case patient with a transient increase of creatinine after operation,renal function returned to normal 7 days after the treatment. ( 3) Follow up:there was no recurrence of hemorrhage after 3?6 months of follow?up. Conclusion Transcatheter embolization in the treatment of intracta?ble hematuria has definite curative effect,less trauma,high safety,less complications and faster postoperative re?covery.
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Objective To evaluate super-selective renal arterial embolization(SRAE)in treating severe renal hemorrhage when conservative treatment had failed. Methods SRAE was performed in 111 patients with severe renal hemorrhage who had failed to respond the conservative management.The clinical data,the way of embolization,the medication and the follow-up findings were retrospectively analyzed.Results Excellent results were obtained in all patients after SRAE and no serious complications occurred.The technical successful rate with single session was 95.5%(106/111).Gross hematuria disappeared within 1-4 days after the treatment.Two patients developed shock after renal embolization and had to receive surgery after the shock was controlled.Three patients had a recurrence of hematuria,the blood urine subsided after SRAE was employed again.A follow-up with a mean period of 37.4 months was carried out in 92 patients,and the follow-up checkups showed that the renal function was well preserved in all patients.Conclusion Super-selective renal artery catheterization and embolization is a safe and effective treatment for severe renal hemorrhage,it can maximally preserve the healthy renal parenchyma as well as the renal function.Therefore,this technique should be regarded as the treatment of first choice for patients with severe renal hemorrhage.